Provider Demographics
NPI:1407841877
Name:BAIRD, THOMAS W
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:BAIRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4004
Mailing Address - Country:US
Mailing Address - Phone:904-264-2988
Mailing Address - Fax:904-269-1411
Practice Address - Street 1:1820 PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4913
Practice Address - Country:US
Practice Address - Phone:904-264-2988
Practice Address - Fax:904-269-1411
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T55728Medicare UPIN
FL88173Medicare ID - Type Unspecified