Healthcare Provider Details

I. General information

NPI: 1477577252
Provider Name (Legal Business Name): MR. DANIEL ROBERT BARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 SE 18TH AVE #B
CAPE CORAL FL
33904-6010
US

IV. Provider business mailing address

4121 SE 18TH AVE #B
CAPE CORAL FL
33904-6010
US

V. Phone/Fax

Practice location:
  • Phone: 239-540-1846
  • Fax: 239-540-1846
Mailing address:
  • Phone: 239-540-1846
  • Fax: 239-540-1846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number0600659152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: