Provider Demographics
NPI:1750378170
Name:BAINES, PAMELA B (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:B
Last Name:BAINES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:SELECT PHYSICIANS ALLIANCE
Mailing Address - Street 2:10002 PRINCESS PALM AVE. STE 332
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-8327
Mailing Address - Country:US
Mailing Address - Phone:813-571-7184
Mailing Address - Fax:813-654-4695
Practice Address - Street 1:FLORIDA ENT & ALLERGY
Practice Address - Street 2:5105 N ARMENIA AVE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1405
Practice Address - Country:US
Practice Address - Phone:813-879-8045
Practice Address - Fax:813-876-6504
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2019-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME070987207YP0228X, 207Y00000X, 207YX0602X
FLME0070987207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250293300Medicaid
FL31681OtherBLUE CROSS BLUE SHIELD
FL31681CMedicare ID - Type Unspecified
FL250293300Medicaid