| Entity Name: | WASHINGTON D. BAQUERO, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Aug 2002 (22 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 14 Apr 2022 (3 years ago) |
| Document Number: | P02000094532 |
| FEI/EIN Number | 900132827 |
| Address: | 1705 COLONIAL BLVD, C-1, FORT MYERS, FL, 33907 |
| Mail Address: | 1705 COLONIAL BLVD, C-1, FORT MYERS, FL, 33907, US |
| ZIP code: | 33907 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124161542 | 2007-02-15 | 2010-12-07 | 1705 COLONIAL BLVD, STE C-1, FORT MYERS, FL, 339071195, US | 1705 COLONIAL BLVD, STE C-1, FORT MYERS, FL, 339071195, US | |||||||||||||||||||||
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| Phone | +1 239-275-4141 |
| Fax | 2392754879 |
Authorized person
| Name | DR. WASHINGTON D. BAQUERO |
| Role | PHYSICIAN |
| Phone | 2392754141 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 038989700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BAQUERO WASHINGTON D MCEO | Agent | 1705 COLONIAL BLVD, FORT MYERS, FL, 33907 |
| Name | Role | Address |
|---|---|---|
| BAQUERO WASHINGTON D | Chief Executive Officer | 1705 COLONIAL BLVD, FORT MYERS, FL, 33907 |
| Name | Role | Address |
|---|---|---|
| BAQUERO MARIA | MEDI | 1705 COLONIAL BLVD STE. C1, FORT MYERS, FL, 33907 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-18 | 1705 COLONIAL BLVD, C-1, FORT MYERS, FL 33907 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-18 | BAQUERO, WASHINGTON D MD, CEO | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-18 | 1705 COLONIAL BLVD, STE C1, FORT MYERS, FL 33907 | No data |
| REINSTATEMENT | 2022-04-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-03-08 | 1705 COLONIAL BLVD, C-1, FORT MYERS, FL 33907 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-18 |
| ANNUAL REPORT | 2023-04-17 |
| REINSTATEMENT | 2022-04-14 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-02-22 |
| ANNUAL REPORT | 2018-01-10 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-03-28 |
| ANNUAL REPORT | 2015-03-03 |
| ANNUAL REPORT | 2014-08-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
