Healthcare Provider Details

I. General information

NPI: 1841287547
Provider Name (Legal Business Name): BARRY F RIGGS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 US HIGHWAY 98 W
MIRAMAR BEACH FL
32550-7228
US

IV. Provider business mailing address

424 RACETRACK RD NW
FORT WALTON BEACH FL
32547-1556
US

V. Phone/Fax

Practice location:
  • Phone: 850-278-3555
  • Fax: 850-278-3562
Mailing address:
  • Phone: 850-314-7575
  • Fax: 850-314-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME74820
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME74820
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME74820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: