Organization
BAPTIST PHYSICIAN GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYON SCOTT RAYNES (PRESIDENT)
(850) 469-2319
Entity
Organization
Contact information
Practice address
8880 NAVARRE PKWY STE 206, NAVARRE, FL 32566-3614
(850) 916-8697
(860) 916-8666
Mailing address
PO BOX 30532, PENSACOLA, FL 32503-1532
(850) 478-1312
(850) 474-9060
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001330100
—
FL
05
—
110608
—
AL
01
—
39662
FLORIDA BLUE
FL
Enumeration date
08/08/2017
Last updated
08/08/2017
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