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NPI Code Detail

MEDICARE: BAXLEY EMERGENCY PHYSICIANS LLC

MEDICARE: BAXLEY EMERGENCY PHYSICIANS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121865OTHERFLBLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538118484
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAXLEY EMERGENCY PHYSICIANS LLC
Provider Business Mailing Address
First Line : 13737 NOEL RD
Second Line : STE 1600
City : DALLAS
State : TX
Zip : 75240-1331
Country : US
Telephone Number : 469-401-2386
Fax Number : 214-712-2444
Provider Business Practice Location Address
First Line : 5637 MARINE PKWY
Second Line :
City : NEW PORT RICHEY
State : FL
Zip : 34652-4316
Country : US
Telephone Number : 727-845-9115
Fax Number : 727-834-5619
Authorized Official
Title or Position : PRESIDENT
Name : DR. GREGROY BYRNE
Credential : M.D.
Telephone Number : 469-401-2386
Provider Enumeration Date : 05/09/2006
Last Update Date : 06/18/2014

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