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General NPI Number Information
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NPI Number | 1568250512
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Entity Type | Organization
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Legal Business Name | BEACHSIDE MEDICAL GROUP LLC
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 5151 N 9TH AVE
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City | PENSACOLA
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State | FL
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Zip | 32504-8721
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Country | US
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Telephone | 850-473-0100
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Fax | 850-473-0500
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Provider Business Mailing Address
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Address Line | 4951 GRANDE DR
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City | PENSACOLA
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State | FL
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Zip | 32504-8965
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Country | US
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Telephone | 850-473-0100
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Fax | 850-473-0500
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | EVIE DUCKWORTH
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Credential |
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Telephone | 850-478-1312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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