Healthcare Provider Details

I. General information

NPI: 1235154741
Provider Name (Legal Business Name): BARRY L BAKST D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 FOULK RD SUITE B
WILMINGTON DE
19810-3644
US

IV. Provider business mailing address

2006 FOULK RD SUITE B
WILMINGTON DE
19810-3644
US

V. Phone/Fax

Practice location:
  • Phone: 302-529-8783
  • Fax: 302-529-7470
Mailing address:
  • Phone: 302-529-8783
  • Fax: 302-529-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberC20002764
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: