Provider Demographics
NPI:1205823499
Name:EFRON, BARRY L (DPM)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:L
Last Name:EFRON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 KINGSLEY AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5129
Mailing Address - Country:US
Mailing Address - Phone:904-272-7070
Mailing Address - Fax:904-272-3668
Practice Address - Street 1:2140 KINGSLEY AVE
Practice Address - Street 2:STE 12
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-272-7070
Practice Address - Fax:904-272-3668
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00001160213E00000X
FLPO1160213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T55477Medicare UPIN
21698KMedicare PIN
87629YMedicare PIN
87629ZMedicare PIN
21698JMedicare PIN