Provider Demographics
NPI:1801033048
Name:BLACKER, BARRY F (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:F
Last Name:BLACKER
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 1:6650 SUNSET WAY APT 217
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-2176
Mailing Address - Country:US
Mailing Address - Phone:727-360-9666
Mailing Address - Fax:727-360-9666
Practice Address - Street 1:6650 SUNSET WAY APT 217
Practice Address - Street 2:
Practice Address - City:ST PETE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33706-2176
Practice Address - Country:US
Practice Address - Phone:727-360-9666
Practice Address - Fax:727-360-9666
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19217208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME19217OtherSTATE LICENCE