Provider Demographics
NPI:1679511802
Name:BARR, J DAVID (PAC)
Entity Type:Individual
Prefix:
First Name:J DAVID
Middle Name:
Last Name:BARR
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:DAVID
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:18865 STATE ROAD 54 # 301
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8201
Mailing Address - Country:US
Mailing Address - Phone:813-459-7711
Mailing Address - Fax:813-235-4175
Practice Address - Street 1:16734 IVY LAKE DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-6020
Practice Address - Country:US
Practice Address - Phone:813-459-7711
Practice Address - Fax:813-235-4175
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZPA9108698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant