Healthcare Provider Details

I. General information

NPI: 1356516744
Provider Name (Legal Business Name): BAYFRONT NEONATOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 6TH ST S
ST PETERSBURG FL
33701-4814
US

IV. Provider business mailing address

700 6TH ST S
ST PETERSBURG FL
33701-4815
US

V. Phone/Fax

Practice location:
  • Phone: 727-893-6095
  • Fax:
Mailing address:
  • Phone: 727-893-6095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT THORNTON
Title or Position: CFO
Credential:
Phone: 727-893-6698