Provider Demographics
NPI:1942203625
Name:BARNES, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:BARNES
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:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:WEWAHITCHKA
Mailing Address - State:FL
Mailing Address - Zip Code:32465-0160
Mailing Address - Country:US
Mailing Address - Phone:850-639-4036
Mailing Address - Fax:850-639-9318
Practice Address - Street 1:412 N HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:WEWAHITCHKA
Practice Address - State:FL
Practice Address - Zip Code:32465-0412
Practice Address - Country:US
Practice Address - Phone:850-639-4036
Practice Address - Fax:850-639-9318
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23728OtherBLUE CROSS BLUE SHIELD
FL378559900Medicaid
FL080135997OtherRAIL ROAD MCARE
FLF27889Medicare UPIN
FL23728AMedicare ID - Type Unspecified