Provider Demographics
NPI:1336103233
Name:BAEZ, JOSE R (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:BAEZ
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:865 GREAT POND RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2035
Mailing Address - Country:US
Mailing Address - Phone:978-387-1375
Mailing Address - Fax:
Practice Address - Street 1:25 MARSTON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2310
Practice Address - Country:US
Practice Address - Phone:978-258-1057
Practice Address - Fax:978-258-1520
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA216181207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2064120Medicaid
MA2064120Medicaid
MAA36972Medicare ID - Type UnspecifiedMASSACHUSETTS MEDICARE