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Organization
PRINCIPLE MEDICAL GROUP, LLC
Active
Organization
PRINCIPLE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROMAN S. BAUTISTA D.O. (PRESIDENT)
(850) 776-4265
Entity
Organization
Contact information
Practice address
7000 COBBLE CRK, PENSACOLA, FL 32504-8638
(850) 776-4265
Mailing address
7000 COBBLE CRK, PENSACOLA, FL 32504-8638
(850) 776-4265
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS7158
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009913418
—
AL
05
—
265911500
—
FL
01
—
59067672
BC/BS OF ALABAMA
AL
01
—
62842
BCBS OF FLORIDA
FL
Enumeration date
03/11/2010
Last updated
02/13/2013
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