Provider Demographics
NPI:1871598128
Name:BASKIN, HENRY JACKSON SR (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JACKSON
Last Name:BASKIN
Suffix:SR
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:PO BOX 3659
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-3659
Mailing Address - Country:US
Mailing Address - Phone:407-628-2521
Mailing Address - Fax:
Practice Address - Street 1:2921 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4627
Practice Address - Country:US
Practice Address - Phone:407-896-2410
Practice Address - Fax:407-898-7106
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME21614207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD82456Medicare UPIN
FL48796Medicare ID - Type Unspecified