Healthcare Provider Details

I. General information

NPI: 1619444502
Provider Name (Legal Business Name): BMR ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 12/04/2025
Certification Date: 07/29/2024
Deactivation Date: 11/19/2025
Reactivation Date: 12/04/2025

III. Provider practice location address

1851 N 9TH AVE STE B
PENSACOLA FL
32503-5201
US

IV. Provider business mailing address

400 10TH ST E
WACONIA MN
55387-4552
US

V. Phone/Fax

Practice location:
  • Phone: 850-479-1805
  • Fax:
Mailing address:
  • Phone: 952-442-9770
  • Fax: 952-442-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: BOBBY RAY BEAL III
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CRNA
Phone: 205-292-5766