Healthcare Provider Details

I. General information

NPI: 1093841074
Provider Name (Legal Business Name): ERNESTO BARRAL MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 SE PORT ST LUCIE BLVD
PORT ST LUCIE FL
34952-5530
US

IV. Provider business mailing address

1847 SE PORT ST LUCIE BLVD
PORT ST LUCIE FL
34952-5530
US

V. Phone/Fax

Practice location:
  • Phone: 772-337-4208
  • Fax:
Mailing address:
  • Phone: 772-337-4208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME94471
License Number StateFL

VIII. Authorized Official

Name: ERNESTO BARRAL
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 772-337-4208