Healthcare Provider Details

I. General information

NPI: 1558761163
Provider Name (Legal Business Name): BARBARA CAROL PERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BARBARA CAROL WOLF M.D.

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 10/07/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 PINE STREET
LEESBURG FL
34748
US

IV. Provider business mailing address

809 PINE ST
LEESBURG FL
34748-6047
US

V. Phone/Fax

Practice location:
  • Phone: 352-250-9526
  • Fax: 352-365-6438
Mailing address:
  • Phone: 352-326-5961
  • Fax: 352-365-6438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberBW 83748
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberME83748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: