Individual
MARY BARBARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1340 S 18TH ST STE 204, FERNANDINA BEACH, FL 32034-4733
(904) 398-7205
Mailing address
4800 BELFORT RD, JACKSONVILLE, FL 32256-6004
(904) 398-7205
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME161241
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003295030A
—
GA
05
—
118678700
—
FL
Enumeration date
07/02/2013
Last updated
10/09/2024
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