Provider Demographics
NPI:1932785359
Name:JEAN BAPTISTE, EDWING (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWING
Middle Name:
Last Name:JEAN BAPTISTE
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 1:11979 SW 28TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-0785
Mailing Address - Country:US
Mailing Address - Phone:954-488-4609
Mailing Address - Fax:
Practice Address - Street 1:6245 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3964
Practice Address - Country:US
Practice Address - Phone:754-273-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE32232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty