Provider Demographics
NPI:1992178750
Name:BARBA, LUIS JEFFERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:JEFFERSON
Last Name:BARBA
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 1:759 HARLEY STRICKLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7954
Mailing Address - Country:US
Mailing Address - Phone:386-200-4656
Mailing Address - Fax:386-200-4655
Practice Address - Street 1:759 HARLEY STRICKLAND BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7954
Practice Address - Country:US
Practice Address - Phone:386-200-4656
Practice Address - Fax:386-200-4655
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN770208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice