Healthcare Provider Details

I. General information

NPI: 1316080393
Provider Name (Legal Business Name): LISA C. BARKLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 QUADRANGLE BLVD
ORLANDO FL
32817-1492
US

IV. Provider business mailing address

3400 QUADRANGLE BLVD
ORLANDO FL
32817-1492
US

V. Phone/Fax

Practice location:
  • Phone: 407-266-3627
  • Fax: 407-882-4814
Mailing address:
  • Phone: 407-266-3627
  • Fax: 407-882-4814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME108870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: