Organization
BLACK BAG MEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN LAYNE STEPHENS MD (PRESIDENT)
(904) 371-4051
Entity
Organization
Contact information
Practice address
4320 DEERWOOD LAKE PKWY, SUITE 101, PMB 321, JACKSONVILLE, FL 32216-1177
(904) 371-4051
(904) 807-4839
Mailing address
4320 DEERWOOD LAKE PKWY, SUITE 101, PMB 321, JACKSONVILLE, FL 32216-1177
(904) 371-4051
(904) 807-4839
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/06/2006
Last updated
08/22/2020
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