Healthcare Provider Details

I. General information

NPI: 1417511742
Provider Name (Legal Business Name): ADAM BARRAGAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 TOWN CENTER PKWY UNIT 112
LAKEWOOD RANCH FL
34202-5012
US

IV. Provider business mailing address

9015 TOWN CENTER PKWY UNIT 112
LAKEWOOD RANCH FL
34202-5012
US

V. Phone/Fax

Practice location:
  • Phone: 941-216-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS18969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: