Provider Demographics
NPI:1497794739
Name:BARRY, WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:BARRY
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 1:397 CADDIE DR
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-4514
Mailing Address - Country:US
Mailing Address - Phone:386-917-0811
Mailing Address - Fax:386-917-0812
Practice Address - Street 1:1055 SAXON BLVD.,
Practice Address - Street 2:FLORIDA HOSPITAL FISH MEMORIAL
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763
Practice Address - Country:US
Practice Address - Phone:386-917-5434
Practice Address - Fax:386-917-5101
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51146207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL221871OtherAMERIGROUP
FL04618OtherBLUE CROSS OF FLORIDA
FL257134000Medicaid
FLP30090443OtherRAILROAD MEDICARE
FL04618VMedicare ID - Type Unspecified
FL04618RMedicare PIN
FLP30090443OtherRAILROAD MEDICARE