Provider Demographics
NPI:1669719514
Name:BARUCH, JACK (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:BARUCH
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 1:781 CRANDON BLVD
Mailing Address - Street 2:SUITE NUMBER 803
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-2543
Mailing Address - Country:US
Mailing Address - Phone:130-536-5579
Mailing Address - Fax:130-536-5579
Practice Address - Street 1:781 CRANDON BLVD
Practice Address - Street 2:SUITE NUMBER 803
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-2543
Practice Address - Country:US
Practice Address - Phone:130-536-5579
Practice Address - Fax:130-536-5579
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125122084P0800X
FLME 125122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry