Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 5975 | FL |
NPI | 1093961591 |
---|---|
Provider Name | Edward Floyd Baines |
First Address | Indialantic, FL 32903-3204 |
Second Address | Indialantic, FL 32903-3204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2008 |
Last Update Date | 15/08/2008 |