Provider Demographics
NPI:1669440566
Name:NELSON M D, BARRINGTON L
Entity Type:Individual
Prefix:
First Name:BARRINGTON
Middle Name:L
Last Name:NELSON M D
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SE HILLMOOR DR
Mailing Address - Street 2:STE C103
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7553
Mailing Address - Country:US
Mailing Address - Phone:772-398-7110
Mailing Address - Fax:772-337-4465
Practice Address - Street 1:1801 SE HILLMOOR DR
Practice Address - Street 2:STE C103
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7553
Practice Address - Country:US
Practice Address - Phone:772-398-7110
Practice Address - Fax:772-337-4465
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 70708207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250403100Medicaid
FL250403100Medicaid
FL31908AMedicare ID - Type Unspecified