Healthcare Provider Details

I. General information

NPI: 1851463731
Provider Name (Legal Business Name): DUDLEY ATKIN BARINGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HEALTH PARK BLVD SUITE 1
ST AUGUSTINE FL
32086-3701
US

IV. Provider business mailing address

120 HEALTH PARK BLVD SUITE 1
ST AUGUSTINE FL
32086-3701
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 Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0040283
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: