Provider Demographics
NPI:1477562791
Name:BARILLAS, BRUCE C (PA)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:C
Last Name:BARILLAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9210
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-9210
Mailing Address - Country:US
Mailing Address - Phone:850-476-8602
Mailing Address - Fax:850-474-3518
Practice Address - Street 1:5151 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8721
Practice Address - Country:US
Practice Address - Phone:850-416-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102363363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL77977OtherBCBS OF ALABAMA
FLP00030954OtherRR MEDICARE
FL291566900Medicaid
AL891005420OtherALABAMA MEDICAID
AL891005420OtherALABAMA MEDICAID
FL291566900Medicaid