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General NPI Number Information
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NPI Number | 1407179989
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Entity Type | Organization
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Legal Business Name | PRINCIPLE MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 7000 COBBLE CRK
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City | PENSACOLA
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State | FL
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Zip | 32504-8638
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Country | US
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Telephone | 850-776-4265
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Fax |
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Provider Business Mailing Address
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Address Line | 7000 COBBLE CRK
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City | PENSACOLA
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State | FL
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Zip | 32504-8638
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Country | US
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Telephone | 850-776-4265
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROMAN S. BAUTISTA
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Credential | D.O.
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Telephone | 850-776-4265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS7158
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License Number State | FL
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