Healthcare Provider Details

I. General information

NPI: 1447338587
Provider Name (Legal Business Name): KENNETH P BARNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17270 SE 109TH TERRACE RD
SUMMERFIELD FL
34491-9015
US

IV. Provider business mailing address

4500 NEWBERRY RD
GAINESVILLE FL
32607-2245
US

V. Phone/Fax

Practice location:
  • Phone: 352-336-6000
  • Fax:
Mailing address:
  • Phone: 352-336-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2007-01088
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberME139531
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberME139531
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number2007-01088
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME139531
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: