MEDICARE: FREDERICK OLEN BARNUM IV D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS17843	FL
2	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	OS17843	FL

General Provider Information

NPI Number	:	1588103659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK OLEN BARNUM IV D.O.

Provider Business Mailing Address
First Line	:	3148 SOUTHGATE CIR STE 2
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-5515
Country	:	US
Telephone Number	:	941-529-6750
Fax Number	:

Provider Business Practice Location Address
First Line	:	3148 SOUTHGATE CIR STE 2
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-5515
Country	:	US
Telephone Number	:	941-529-6750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	08/01/2024

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