Provider Demographics
NPI:1669463576
Name:FARE, BARBARA L (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:L
Last Name:FARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2583 S VOLUSIA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-9129
Mailing Address - Country:US
Mailing Address - Phone:386-456-2080
Mailing Address - Fax:386-456-2122
Practice Address - Street 1:2583 S VOLUSIA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-9129
Practice Address - Country:US
Practice Address - Phone:386-456-2080
Practice Address - Fax:386-456-2122
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H72410Medicare UPIN