# BAPTIST PHYSICIAN GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609392018
- **Authorized official:** BRYON SCOTT RAYNES (PRESIDENT)
- **Authorized official phone:** (850) 469-2319

## Contact information

- **Practice address:** 9400 UNIVERSITY PKWY STE 101A, PENSACOLA, FL 32514-5485
- **Practice address phone:** (850) 916-3700
- **Practice address fax:** (850) 916-3710
- **Mailing address:** PO BOX 30532, PENSACOLA, FL 32503-1532
- **Mailing address phone:** (850) 478-1312
- **Mailing address fax:** (850) 474-9060

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |
| 207RS0010X | Sports Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RS0010X | Sports Medicine (Internal Medicine) Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 08/17/2017
- **Last updated:** 08/17/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001330100 | — | FL |
| 01 | — | 39662 | FLORIDA BLUE | FL |