Provider Demographics
NPI:1851362404
Name:BAVINGER, JAMES VETTER (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:VETTER
Last Name:BAVINGER
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 95004
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-5004
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:863-680-7420
Practice Address - Street 1:1033 N PARKWAY FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-0401
Practice Address - Country:US
Practice Address - Phone:863-647-8011
Practice Address - Fax:863-647-8029
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41946207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B48125Medicare UPIN
FL0471260003Medicare NSC
FL02556ZMedicare PIN