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General NPI Number Information
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NPI Number | 1124000856
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Entity Type | Organization
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Legal Business Name | SOUTH BALDWIN DIAGNOSTIC IMAGINE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 1613 N MCKENZIE ST
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City | FOLEY
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State | AL
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Zip | 36535-2247
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Country | US
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Telephone | 251-949-1513
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Fax | 251-476-5460
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Provider Business Mailing Address
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Address Line | PO BOX 160550
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32716-0550
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Country | US
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Telephone | 713-559-6929
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Fax | 713-559-6928
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MARK R CONNELL
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Credential | M.D.
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Telephone | 251-949-3513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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