Provider Demographics
NPI:1295841476
Name:POLINER, BARRY STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:STEVEN
Last Name:POLINER
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 1:33 OLD KINGS RD N STE 3
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8238
Mailing Address - Country:US
Mailing Address - Phone:386-445-1100
Mailing Address - Fax:
Practice Address - Street 1:33 OLD KINGS RD N STE 3
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8238
Practice Address - Country:US
Practice Address - Phone:386-445-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15797Medicare PIN
FLA80687Medicare UPIN