Basic Information
| Provider Information | |||||||||
| NPI: | 1639335573 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAEZ-IRIZARRY | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 506 EAST CHEVES STREET | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777010 | ||||||||
| FaxNumber: | 8437777006 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 JOHNS ST | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437775701 | ||||||||
| FaxNumber: | 8437777320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2008 | ||||||||
| LastUpdateDate: | 07/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | 37465 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 2149636 | 05 | LA | MEDICAID |