Provider Demographics
NPI:1336189778
Name:BAZ, MAHER A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHER
Middle Name:A
Last Name:BAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAHER
Other - Middle Name:ALIF
Other - Last Name:BAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4500 SAN PABLO RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1865
Mailing Address - Country:US
Mailing Address - Phone:904-953-2000
Mailing Address - Fax:904-953-0115
Practice Address - Street 1:4500 SAN PABLO RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1865
Practice Address - Country:US
Practice Address - Phone:904-953-2000
Practice Address - Fax:904-953-0115
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073016A207RP1001X
FLME69989207RP1001X
KY48159207RP1001X, 208G00000X
FL69989207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201180030Medicaid
FL250004300Medicaid
68759ZMedicare PIN
INP01272868Medicare PIN
IN267030030Medicare PIN
FL250004300Medicaid