Provider Demographics
NPI:1851463731
Name:BARINGER, DUDLEY ATKIN (MD)
Entity Type:Individual
Prefix:
First Name:DUDLEY
Middle Name:ATKIN
Last Name:BARINGER
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 1:120 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3701
Mailing Address - Country:US
Mailing Address - Phone:904-823-3401
Mailing Address - Fax:904-829-8649
Practice Address - Street 1:120 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3701
Practice Address - Country:US
Practice Address - Phone:904-823-3401
Practice Address - Fax:904-829-8649
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20054OtherOTHER
FLD53397Medicare UPIN
FL20054YMedicare ID - Type UnspecifiedMEDICARE