Healthcare Provider Details

I. General information

NPI: 1801033048
Provider Name (Legal Business Name): BARRY F BLACKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 SUNSET WAY APT 217
ST PETE BEACH FL
33706-2176
US

IV. Provider business mailing address

6650 SUNSET WAY APT 217
ST PETE BEACH FL
33706-2176
US

V. Phone/Fax

Practice location:
  • Phone: 727-360-9666
  • Fax: 727-360-9666
Mailing address:
  • Phone: 727-360-9666
  • Fax: 727-360-9666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME19217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: