Provider Demographics
NPI:1144227927
Name:WATERS, BARRY K (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:K
Last Name:WATERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 NW 33RD ST STE 204
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4081
Mailing Address - Country:US
Mailing Address - Phone:954-341-5034
Mailing Address - Fax:954-341-9190
Practice Address - Street 1:9750 NW 33RD ST STE 204
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-341-5034
Practice Address - Fax:954-341-9190
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2018-06-11
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
FLME0047508174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27804Medicare UPIN