Provider Demographics
NPI:1588103659
Name:BARNUM, FREDERICK OLEN IV (DO)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:OLEN
Last Name:BARNUM
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3148 SOUTHGATE CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5515
Mailing Address - Country:US
Mailing Address - Phone:941-529-6750
Mailing Address - Fax:
Practice Address - Street 1:3148 SOUTHGATE CIR STE 2
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5515
Practice Address - Country:US
Practice Address - Phone:941-529-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17843207Q00000X, 204D00000X, 207Q00000X
TXR8700207Q00000X
TXBP10058782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM