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General NPI Number Information
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NPI Number | 1447352760
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Entity Type | Individual
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Provider Name | JUAN R BARALT M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 619 SOUTH MARION
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City | LAKE CITY
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State | FL
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Zip | 32025-5808
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Country | US
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Telephone | 386-755-3016
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Fax |
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Provider Business Mailing Address
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Address Line | #1329 NW 101ST DRIVE
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City | GAINESVILLE
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State | FL
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Zip | 32606-8036
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Country | US
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Telephone | 352-332-5740
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MD013556
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License Number State | LA
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