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General NPI Number Information
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NPI Number | 1295841476
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Entity Type | Individual
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Provider Name | BARRY STEVEN POLINER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 33 OLD KINGS RD N STE 3
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City | PALM COAST
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State | FL
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Zip | 32137-8238
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Country | US
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Telephone | 386-445-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 33 OLD KINGS RD N STE 3
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City | PALM COAST
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State | FL
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Zip | 32137-8238
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Country | US
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Telephone | 386-445-1100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME44802
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License Number State | FL
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