Organization
BAYSIDE PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND D.A. PETERSON M.D. (OWNER)
(251) 300-2033
Entity
Organization
Contact information
Practice address
28490 2ND ST, DAPHNE, AL 36526-7150
(251) 300-2030
Mailing address
28490 2ND ST, DAPHNE, AL 36526-7150
(251) 300-2030
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
00006735
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529926260
—
AL
Enumeration date
02/03/2012
Last updated
02/03/2012
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