Healthcare Provider Details

I. General information

NPI: 1780837500
Provider Name (Legal Business Name): ELIZABETH GAYNELL BARNES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 BOATNER RD
EGLIN AFB FL
32542-1391
US

IV. Provider business mailing address

340 BOATNER RD
EGLIN AFB FL
32542-1391
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-8780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME114699
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: