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General NPI Number Information
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NPI Number | 1356993398
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Entity Type | Individual
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Provider Name | GARY BARBOSA DPM
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Gender | Male
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 3182 EDGEMOORE DRIVE
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City | PALM HARBOR
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State | FL
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Zip | 34685
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Country | US
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Telephone | 727-787-2158
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Fax |
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Provider Business Mailing Address
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Address Line | 36181 E LAKE RD STE 185
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City | PALM HARBOR
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State | FL
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Zip | 34685-3142
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Country | US
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Telephone | 727-787-2158
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO1415
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License Number State | FL
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