Provider Demographics
NPI:1770788689
Name:BARRIOS, MARTIN ACEVEDO (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:ACEVEDO
Last Name:BARRIOS
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 1:540 JETT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-9622
Mailing Address - Country:US
Mailing Address - Phone:813-380-4905
Mailing Address - Fax:
Practice Address - Street 1:4881 PALM BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-3217
Practice Address - Country:US
Practice Address - Phone:813-380-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98414208600000X
KY42222207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2088498OtherUNITED HEALTHCARE
FL312370OtherAV MED
FL17804OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL1770788689OtherHUMANA
FL19797OtherEVOLUTIONS
FL7564915OtherAETNA
FL17804OtherBLUE CROSS BLUE SHIELD OF FLORIDA