Provider Demographics
NPI:1073527479
Name:MARK, BARRY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JAY
Last Name:MARK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11880 SW 40TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-223-8808
Mailing Address - Fax:305-223-8974
Practice Address - Street 1:21150 BISCAYNE BLVD
Practice Address - Street 2:SUITE 408
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1226
Practice Address - Country:US
Practice Address - Phone:305-932-3252
Practice Address - Fax:305-932-2798
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2015-09-21
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Provider Licenses
StateLicense IDTaxonomies
FLME88114207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276214500Medicaid
FLBI362XMedicare PIN
FLBI362YMedicare PIN