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General NPI Number Information
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NPI Number | 1376140897
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Entity Type | Organization
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Legal Business Name | BARRY S POLINER MD
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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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 | 24 CURRY CT
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City | PALM COAST
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State | FL
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Zip | 32137-9003
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Country | US
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Telephone | 386-445-1304
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BARRY S POLINER
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Credential | MD
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Telephone | 386-445-1304
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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 |
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License Number State |
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