Provider Demographics
NPI:1700819893
Name:BARNARD, GRANDY B III (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANDY
Middle Name:B
Last Name:BARNARD
Suffix:III
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 1:809 N STONE ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3255
Mailing Address - Country:US
Mailing Address - Phone:386-734-1824
Mailing Address - Fax:386-738-7497
Practice Address - Street 1:809 N STONE ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3255
Practice Address - Country:US
Practice Address - Phone:386-734-1824
Practice Address - Fax:386-738-7497
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0024955208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4052215OtherAETNA
FL78588OtherBLUE CROSS
FL0024955OtherME#
FL622OtherFHC
FLAB6804694OtherDEA
FLAB6804694OtherDEA
FLWV220329Medicare ID - Type UnspecifiedMEDICARE