Provider Demographics
NPI:1962469981
Name:BARNES, RONALD LEE (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LEE
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 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6796
Mailing Address - Country:US
Mailing Address - Phone:850-863-6600
Mailing Address - Fax:850-862-0977
Practice Address - Street 1:2001 E. HIGHWAY 20
Practice Address - Street 2:FAMILY MEDICINE DEPARTMENT
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578
Practice Address - Country:US
Practice Address - Phone:850-897-4400
Practice Address - Fax:850-897-0623
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113886207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020526000Medicaid
FL020526000Medicaid
ILH14969Medicare UPIN