Individual
MR. BARRY G MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2140 KINGSLEY AVE STE 1, ORANGE PARK, FL 32073-5129
(904) 272-7500
(904) 272-7502
Mailing address
2140 KINGSLEY AVE STE 1, ORANGE PARK, FL 32073-5129
(904) 272-7500
(904) 272-7502
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1751
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2908077-00
—
FL
Enumeration date
07/19/2006
Last updated
05/06/2009
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