Healthcare Provider Details

I. General information

NPI: 1689865131
Provider Name (Legal Business Name): BARRY LEE HUMMEL JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5944 CORAL RIDGE DR # 255
CORAL SPRINGS FL
33076
US

IV. Provider business mailing address

5944 CORAL RIDGE DR # 255
CORAL SPRINGS FL
33076-3300
US

V. Phone/Fax

Practice location:
  • Phone: 877-878-4755
  • Fax: 877-878-4755
Mailing address:
  • Phone: 877-878-4755
  • Fax: 877-878-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberME93603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: