| Entity Name: | JOSE M. BAEZ, MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Aug 2016 (8 years ago) |
| Document Number: | L16000156834 |
| FEI/EIN Number | 81-3644700 |
| Address: | 11181 HEALTH PARK BOULEVARD,, NAPLES, FL, 34110, US |
| Mail Address: | 11181 HEALTH PARK BOULEVARD,, NAPLES, FL, 34110, US |
| ZIP code: | 34110 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306392436 | 2016-08-29 | 2022-07-21 | 11181 HEALTH PARK BLVD, SUITE 1180, NAPLES, FL, 341105738, US | 11181 HEALTH PARK BLVD STE 1180, NAPLES, FL, 341105734, US | |||||||||||||||||||||||
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| Phone | +1 239-777-0663 |
| Fax | 2397771296 |
Authorized person
| Name | DR. JOSE MIGUEL BAEZ |
| Role | MEMBER |
| Phone | 2397770663 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME110612 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI |
| Number | 1235218397 |
| Name | Role | Address |
|---|---|---|
| NULAND CHRISTOPHER L | Agent | 4427 Herschel Street, JACKSONVILLE, FL, 32210 |
| Name | Role | Address |
|---|---|---|
| BAEZ JOSE MMD | Managing Member | 11181 HEALTH PARK BOULEVARD # 1180, NAPLES, FL, 34110 |
| BAEZ MARISOL | Managing Member | 11181 HEALTH PARK BOULEVARD #1180, NAPLES, FL, 34110 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000091888 | GULFSHORE DIRECT PRIMARY CARE | EXPIRED | 2018-08-17 | 2023-12-31 | No data | 11181 HEALTH PARK BLVD, SUITE 1180, NAPLES, FL, 34110 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-31 | 4427 Herschel Street, JACKSONVILLE, FL 32210 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-06-16 | 11181 HEALTH PARK BOULEVARD,, SUITE #1180, NAPLES, FL 34110 | No data |
| CHANGE OF MAILING ADDRESS | 2017-06-16 | 11181 HEALTH PARK BOULEVARD,, SUITE #1180, NAPLES, FL 34110 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-02-13 |
| ANNUAL REPORT | 2022-02-26 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-02-18 |
| ANNUAL REPORT | 2017-01-16 |
| Florida Limited Liability | 2016-08-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
