Bay Side Medical Center LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS3212 Issued in FL

Legal business name

BAY SIDE MEDICAL CENTER LLC

Practice address

9545 Bay Pines Blvd
St Petersburg, FL 33708-3754

Phone

(727) 393-8715

Fax

(727) 393-8717

NPI assigned

Sep 28, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Leo Bernard Dalton, D.O.

Title

Owner

Phone

(727) 393-8715

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Leo B. Dalton, D.O. Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285632000000",
    "number": "1114236940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9545 BAY PINES BLVD",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337083754",
            "telephone_number": "727-393-8715",
            "fax_number": "727-393-8717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9545 BAY PINES BLVD",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337083754",
            "telephone_number": "727-393-8715",
            "fax_number": "727-393-8717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY SIDE MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-28",
        "last_updated": "2010-09-28",
        "status": "A",
        "authorized_official_last_name": "DALTON",
        "authorized_official_first_name": "LEO",
        "authorized_official_middle_name": "BERNARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-393-8715",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS3212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "OS3212",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040070000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Leo B. Dalton, D.O.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Family Medicine Physician in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.