Provider Demographics
NPI:1063734689
Name:PAUL J BARRESE MD PA
Entity type:Organization
Organization Name:PAUL J BARRESE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BARRESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-778-2271
Mailing Address - Street 1:3909 E BAY DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOLMES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34217-1997
Mailing Address - Country:US
Mailing Address - Phone:941-778-2271
Mailing Address - Fax:941-778-1311
Practice Address - Street 1:3909 E BAY DR
Practice Address - Street 2:SUITE 210
Practice Address - City:HOLMES BEACH
Practice Address - State:FL
Practice Address - Zip Code:34217-1997
Practice Address - Country:US
Practice Address - Phone:941-778-2271
Practice Address - Fax:941-778-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 41807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54735Medicare UPIN