Provider Demographics
NPI:1730512120
Name:BAITIS, JEFFREY HEINRICH (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HEINRICH
Last Name:BAITIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 GROVER ST STE D1
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1539
Mailing Address - Country:US
Mailing Address - Phone:360-354-1333
Mailing Address - Fax:360-354-5399
Practice Address - Street 1:1610 GROVER ST STE D1
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1539
Practice Address - Country:US
Practice Address - Phone:360-354-1333
Practice Address - Fax:360-354-5399
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA864207Q00000X
WAMD61259589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine