Provider Demographics
NPI:1215139001
Name:BARRICK, KENNETH R (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:BARRICK
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 1:15939 NW 10TH CIR
Mailing Address - Street 2:
Mailing Address - City:CITRA
Mailing Address - State:FL
Mailing Address - Zip Code:32113-4906
Mailing Address - Country:US
Mailing Address - Phone:630-460-4727
Mailing Address - Fax:
Practice Address - Street 1:7340 N US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-6783
Practice Address - Country:US
Practice Address - Phone:630-460-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118877207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine