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General NPI Number Information
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NPI Number | 1720322811
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Entity Type | Organization
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Legal Business Name | BAPTIST PHYSICIAN GROUP LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 08/08/2017
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Provider Practice Location Address
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Address Line | 9400 UNIVERSITY PKWY SUITE 309
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City | PENSACOLA
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State | FL
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Zip | 32514-5752
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Country | US
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Telephone | 850-479-3320
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Fax | 850-479-8789
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Provider Business Mailing Address
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Address Line | PO BOX 30532
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City | PENSACOLA
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State | FL
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Zip | 32503-1532
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Country | US
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Telephone | 850-478-1312
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Fax | 850-474-9060
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRYON SCOTT RAYNES
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Credential |
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Telephone | 850-469-2319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME69848
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License Number State | FL
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