Provider Demographics
NPI:1184612269
Name:BARBER, KEVIN M (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:BARBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1592 SOUTH STATE ROAD 15-A
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720
Mailing Address - Country:US
Mailing Address - Phone:386-734-2931
Mailing Address - Fax:386-734-2939
Practice Address - Street 1:1592 SOUTH STATE ROAD 15-A
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-734-2931
Practice Address - Fax:386-734-2939
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME96319207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF6552OtherMEDICARE PTAN
FLP00477812OtherMEDICARE RR