Healthcare Provider Details

I. General information

NPI: 1396085338
Provider Name (Legal Business Name): BAY MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

IV. Provider business mailing address

2316 W BEACH DR
PANAMA CITY FL
32401-1657
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-6050
  • Fax:
Mailing address:
  • Phone: 985-665-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number9306056
License Number StateFL

VIII. Authorized Official

Name: MR. ANTHONY JOHN CUROLE II
Title or Position: CRNA
Credential: CRNA
Phone: 985-665-2583