Provider Demographics
NPI:1255462420
Name:BAPTISTA, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BAPTISTA
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 1:1205 MONUMENT RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7406
Mailing Address - Country:US
Mailing Address - Phone:904-724-2263
Mailing Address - Fax:904-723-3007
Practice Address - Street 1:1205 MONUMENT RD
Practice Address - Street 2:SUITE 302
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7406
Practice Address - Country:US
Practice Address - Phone:904-724-2263
Practice Address - Fax:904-723-3007
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97866174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist