# BEACHSIDE MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BEACHSIDE MEDICAL GROUP LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1740078799
- **Legal business name:** BEACHSIDE MEDICAL GROUP LLC
- **Authorized official:** EVIE DUCKWORTH (CREDENTIALING MANAGER)
- **Authorized official phone:** (850) 478-1312

## Contact information

- **Practice address:** 8383 N DAVIS HWY, PENSACOLA, FL 32514-6039
- **Practice address phone:** (850) 473-0100
- **Practice address fax:** (850) 473-0500
- **Mailing address:** 4951 GRANDE DR, PENSACOLA, FL 32504-8965
- **Mailing address phone:** (850) 473-0100
- **Mailing address fax:** (850) 473-0500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | NULL | Yes |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/29/2025
- **Last updated:** 04/29/2025