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General NPI Number Information
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NPI Number | 1306059092
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Entity Type | Individual
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Provider Name | JUAN BARRIOS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 3030 HARDEN BLVD STE 108 WOUND CARE CENTER
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City | LAKELAND
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State | FL
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Zip | 33803-7973
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Country | US
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Telephone | 863-284-1700
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Fax | 863-284-1728
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Provider Business Mailing Address
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Address Line | 1324 LAKELAND HILLS BLVD ATTN: MEDICAL STAFF OFFICE
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City | LAKELAND
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State | FL
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Zip | 33805-4543
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Country | US
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Telephone |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME21611
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License Number State | FL
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