Healthcare Provider Details

I. General information

NPI: 1497794739
Provider Name (Legal Business Name): WAYNE BARRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 SAXON BLVD., FLORIDA HOSPITAL FISH MEMORIAL
ORANGE CITY FL
32763
US

IV. Provider business mailing address

397 CADDIE DR
DEBARY FL
32713-4514
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-5434
  • Fax: 386-917-5101
Mailing address:
  • Phone: 386-917-0811
  • Fax: 386-917-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME51146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: