Provider Demographics
NPI:1780874628
Name:BAYTREE MEDICAL GROUP LLC
Entity type:Organization
Organization Name:BAYTREE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:P
Authorized Official - Last Name:HUNTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-254-6803
Mailing Address - Street 1:8040 N WICKHAM RD
Mailing Address - Street 2:STE 102
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8298
Mailing Address - Country:US
Mailing Address - Phone:321-254-6803
Mailing Address - Fax:321-254-6819
Practice Address - Street 1:8040 N WICKHAM RD
Practice Address - Street 2:STE 102
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8298
Practice Address - Country:US
Practice Address - Phone:321-254-6803
Practice Address - Fax:321-254-6819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty