Provider Demographics
NPI:1750494555
Name:BAEZ, ROSAURA E (MD)
Entity Type:Individual
Prefix:
First Name:ROSAURA
Middle Name:E
Last Name:BAEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 S TAMIAMI TRL STE 2
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5121
Mailing Address - Country:US
Mailing Address - Phone:941-584-9201
Mailing Address - Fax:941-584-9202
Practice Address - Street 1:4125 S TAMIAMI TRL STE 2
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5121
Practice Address - Country:US
Practice Address - Phone:941-584-9201
Practice Address - Fax:941-584-9202
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56560OtherBCBS
FL201841070OtherTAX ID
FLG66741Medicare UPIN