Healthcare Provider Details

I. General information

NPI: 1033184858
Provider Name (Legal Business Name): BARRY STUART YARCKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 WEST COLONIAL DRIVE STE 102
OCOEE FL
34761-4212
US

IV. Provider business mailing address

10125 W COLONIAL DR STE 102
OCOEE FL
34761-4211
US

V. Phone/Fax

Practice location:
  • Phone: 407-290-9355
  • Fax: 407-295-0033
Mailing address:
  • Phone: 407-290-9355
  • Fax: 407-295-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0047450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: