Provider Demographics
NPI:1154620169
Name:BAPTIST OBSTETRICS AND GYNECOLOGY INC
Entity type:Organization
Organization Name:BAPTIST OBSTETRICS AND GYNECOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-376-4275
Mailing Address - Street 1:12341 YELLOW BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2025
Mailing Address - Country:US
Mailing Address - Phone:904-225-2779
Mailing Address - Fax:904-225-8477
Practice Address - Street 1:12341 YELLOW BLUFF RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-2025
Practice Address - Country:US
Practice Address - Phone:904-225-2779
Practice Address - Fax:904-225-8477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62735207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty