Healthcare Provider Details

I. General information

NPI: 1073280095
Provider Name (Legal Business Name): BAPTIST MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 GULF BREEZE PKWY STE 206
GULF BREEZE FL
32561-7808
US

IV. Provider business mailing address

PO BOX 17567
PENSACOLA FL
32522-7567
US

V. Phone/Fax

Practice location:
  • Phone: 850-916-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JULIE CARDWELL
Title or Position: PRESIDENT
Credential:
Phone: 850-469-2178