Provider Demographics
NPI:1669875670
Name:JEAN BAPTISTE, ESDRA (MD)
Entity type:Individual
Prefix:
First Name:ESDRA
Middle Name:
Last Name:JEAN BAPTISTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ESDRA
Other - Middle Name:
Other - Last Name:JEAN BAPTISTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5040 LONG LAKE CIR
Mailing Address - Street 2:304
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-9581
Mailing Address - Country:US
Mailing Address - Phone:410-845-9295
Mailing Address - Fax:863-582-9265
Practice Address - Street 1:4435 US HIGHWAY 98 N
Practice Address - Street 2:SUIT B
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-0402
Practice Address - Country:US
Practice Address - Phone:863-858-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18853208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice