Organization
BAPTIST SPECIALTY PHYSICIANS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THABATA FORD (VICE PRESIDENT)
(904) 391-5578
Entity
Organization
Contact information
Practice address
1219 DUNN AVE, DAYTONA BEACH, FL 32114-2405
(904) 202-8550
(904) 393-7808
Mailing address
PO BOX 44047, JACKSONVILLE, FL 32231-4047
(904) 376-4083
(904) 391-5075
Taxonomy
Speciality
Code
Description
License number
State
207RA0002X
Adult Congenital Heart Disease Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
2080P0202X
Pediatric Cardiology Physician
Primary
—
—
Other
Enumeration date
05/20/2021
Last updated
05/20/2021
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