Provider Demographics
NPI:1639176993
Name:BAQUERO, JAIME A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:A
Last Name:BAQUERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:2068 HAWTHORNE ST STE 101
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2368
Practice Address - Country:US
Practice Address - Phone:941-952-9223
Practice Address - Fax:941-955-0642
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143582207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30202230Medicaid
NH30202230Medicaid
NHH63240Medicare UPIN