Provider Demographics
NPI:1679500854
Name:BARNES, RAYMOND FAY (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:FAY
Last Name:BARNES
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 1:1350 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-5065
Mailing Address - Country:US
Mailing Address - Phone:863-533-0441
Mailing Address - Fax:863-533-5593
Practice Address - Street 1:1350 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-5065
Practice Address - Country:US
Practice Address - Phone:863-533-0441
Practice Address - Fax:863-533-5593
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026643207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041945100Medicaid
FL53497OtherBCBS
FL53497Medicare ID - Type Unspecified
FLD64485Medicare UPIN