Organization
BAPTIST PHYSICIAN GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYON SCOTT RAYNES (PRESIDENT)
(850) 469-2319
Entity
Organization
Contact information
Practice address
1040 GULF BREEZE PKWY, SUITE 200, GULF BREEZE, FL 32561-7809
(850) 916-3700
(850) 916-3710
Mailing address
PO BOX 30532, PENSACOLA, FL 32503-1532
(850) 916-3700
(850) 916-3710
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207XX0005X
Sports Medicine (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
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/29/2007
Last updated
07/21/2022
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