Provider Demographics
NPI:1417912197
Name:BAFFOE-BONNIE, IGNATIUS HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:IGNATIUS
Middle Name:HENRY
Last Name:BAFFOE-BONNIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91177
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-1177
Mailing Address - Country:US
Mailing Address - Phone:863-682-7246
Mailing Address - Fax:863-682-5566
Practice Address - Street 1:202 PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4548
Practice Address - Country:US
Practice Address - Phone:863-682-7246
Practice Address - Fax:863-682-5566
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84089207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263178400Medicaid
FLF66940Medicare UPIN
FL06503AMedicare ID - Type Unspecified