Active NPI
Vivencio Paclibar Baitan, M.D.
- Surgery Physician
- Macclenny, FL
National Provider Identifier
1619145372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- LL549
- Practice address
- 7487 S State Road 121
Macclenny, FL 32063-5451 - Phone
- (904) 259-6211
- Fax
- (904) 259-7104
- NPI assigned
- Feb 15, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | LL549 | FL | Primary |
Addresses
Primary practice location
7487 S State Road 121
Macclenny, FL 32063-5451
Mailing address
7487 S State Road 121
Macclenny, FL 32063-5451
Phone (904) 259-6211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL549 | FL | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203033600000",
"number": "1619145372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7487 S STATE ROAD 121",
"city": "MACCLENNY",
"state": "FL",
"postal_code": "320635451",
"telephone_number": "904-259-6211",
"fax_number": "904-259-7104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7487 S STATE ROAD 121",
"city": "MACCLENNY",
"state": "FL",
"postal_code": "320635451",
"telephone_number": "904-259-6211",
"fax_number": "904-259-7104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAITAN",
"first_name": "VIVENCIO",
"middle_name": "PACLIBAR",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-15",
"last_updated": "2008-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "FL",
"license": "LL549",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macclenny, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.