Provider Demographics
NPI:1659378347
Name:BARRESE, PAUL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOSEPH
Last Name:BARRESE
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 1:3909 E BAY DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOLMES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34217-1997
Mailing Address - Country:US
Mailing Address - Phone:941-778-2271
Mailing Address - Fax:941-778-1311
Practice Address - Street 1:3909 E BAY DR
Practice Address - Street 2:SUITE 210
Practice Address - City:HOLMES BEACH
Practice Address - State:FL
Practice Address - Zip Code:34217-1997
Practice Address - Country:US
Practice Address - Phone:941-778-2271
Practice Address - Fax:941-778-1311
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMEOO41807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54735Medicare UPIN
FL41215Medicare ID - Type Unspecified