Provider Demographics
NPI:1649373523
Name:BACA, SHAWN B (MD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:B
Last Name:BACA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1050 NW 15TH ST
Mailing Address - Street 2:SUITE 208A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1375
Mailing Address - Country:US
Mailing Address - Phone:561-368-5611
Mailing Address - Fax:561-368-4745
Practice Address - Street 1:5162 LINTON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6567
Practice Address - Country:US
Practice Address - Phone:561-498-1114
Practice Address - Fax:561-498-8338
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
FLME 53832207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14768VMedicare ID - Type Unspecified
FLF22732Medicare UPIN