Organization
BAY SIDE MEDICAL CENTER LLC
Active
Other names
Leo B. Dalton, D.O.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEO BERNARD DALTON D.O. (OWNER)
(727) 393-8715
Entity
Organization
Contact information
Practice address
9545 BAY PINES BLVD, ST PETERSBURG, FL 33708-3754
(727) 393-8715
(727) 393-8717
Mailing address
9545 BAY PINES BLVD, ST PETERSBURG, FL 33708-3754
(727) 393-8715
(727) 393-8717
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS3212
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040070000
—
FL
01
—
OS3212
STATE LICENSE NUMBER
FL
Enumeration date
09/28/2010
Last updated
09/28/2010
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