Healthcare Provider Details

I. General information

NPI: 1972677227
Provider Name (Legal Business Name): DUDLEY A BARINGER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HEALTH PARK BLVD STE 1
SAINT AUGUSTINE FL
32086-5798
US

IV. Provider business mailing address

120 HEALTH PARK BLVD STE 1
SAINT AUGUSTINE FL
32086-5798
US

V. Phone/Fax

Practice location:
  • Phone: 904-823-3401
  • Fax: 904-829-8649
Mailing address:
  • Phone: 904-823-3401
  • Fax: 904-829-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME0040283
License Number StateFL

VIII. Authorized Official

Name: DUDLEY A BARINGER
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 904-823-3401