Provider Demographics
NPI:1396766911
Name:BAY FAMILY MEDICINE PA
Entity type:Organization
Organization Name:BAY FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ARMISTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-763-3635
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-0097
Mailing Address - Country:US
Mailing Address - Phone:850-763-3635
Mailing Address - Fax:850-763-4448
Practice Address - Street 1:2420 JENKS AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4909
Practice Address - Country:US
Practice Address - Phone:850-763-3635
Practice Address - Fax:850-763-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64058OtherBCBS FLORIDA
FL64058OtherBCBS FLORIDA