Provider Demographics
NPI:1699853044
Name:ARTHRITIS & RHEUMATOLOGY CLINIC PA
Entity Type:Organization
Organization Name:ARTHRITIS & RHEUMATOLOGY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BSHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAKAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-389-2707
Mailing Address - Street 1:2119 OAK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4410
Mailing Address - Country:US
Mailing Address - Phone:904-389-2707
Mailing Address - Fax:904-389-7009
Practice Address - Street 1:2119 OAK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4410
Practice Address - Country:US
Practice Address - Phone:904-389-2707
Practice Address - Fax:904-389-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68949174400000X
FLME75096174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2550Medicare ID - Type Unspecified