Healthcare Provider Details

I. General information

NPI: 1588103659
Provider Name (Legal Business Name): FREDERICK OLEN BARNUM IV D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3148 SOUTHGATE CIR STE 2
SARASOTA FL
34239-5515
US

IV. Provider business mailing address

3148 SOUTHGATE CIR STE 2
SARASOTA FL
34239-5515
US

V. Phone/Fax

Practice location:
  • Phone: 941-529-6750
  • Fax:
Mailing address:
  • Phone: 941-529-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS17843
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS17843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: