Provider Demographics
NPI:1508867409
Name:BARBARA, JOAQUIN JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:JOSE
Last Name:BARBARA
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 1:9212 SW 78TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7590
Mailing Address - Country:US
Mailing Address - Phone:305-412-6735
Mailing Address - Fax:305-514-0063
Practice Address - Street 1:9212 SW 78TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7590
Practice Address - Country:US
Practice Address - Phone:305-412-6735
Practice Address - Fax:305-514-0063
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248479207R00000X
FLME81166208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260470100Medicaid
FL260470100Medicaid
FL58629Medicare PIN
FL58629XMedicare PIN