Provider Demographics
NPI:1962509521
Name:BAQUERO, WASHINGTON DARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:WASHINGTON
Middle Name:DARIO
Last Name:BAQUERO
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 1:1705 COLONIAL BLVD STE C1
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1197
Mailing Address - Country:US
Mailing Address - Phone:239-275-4141
Mailing Address - Fax:239-275-4879
Practice Address - Street 1:1705 COLONIAL BLVD STE C1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1197
Practice Address - Country:US
Practice Address - Phone:239-275-4141
Practice Address - Fax:239-275-4879
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0034296F207Q00000X
FLME34296207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine