Basic Information
| Provider Information | |||||||||
| NPI: | 1699922781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAEZ LORENZO | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11945 SAN JOSE BLVD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322231627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043961725 | ||||||||
| FaxNumber: | 9043991717 | ||||||||
| Practice Location | |||||||||
| Address1: | 1715 EAGLE HARBOR PKWY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FLEMING ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320034324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042152422 | ||||||||
| FaxNumber: | 9042156122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2008 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | ME111421 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 208600000X | ME111421 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0105X | ME111471 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand |
No ID Information.