Basic Information
| Provider Information | |||||||||
| NPI: | 1104058874 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST NEUROLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 41113 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322031113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043764400 | ||||||||
| FaxNumber: | 9043915595 | ||||||||
| Practice Location | |||||||||
| Address1: | 1370 13TH AVE S | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | JACKSONVILLE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322503230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042491041 | ||||||||
| FaxNumber: | 9042499764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2009 | ||||||||
| LastUpdateDate: | 06/25/2010 | ||||||||
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| AuthorizedOfficialLastName: | MALLY | ||||||||
| AuthorizedOfficialFirstName: | EARL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9043764275 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.