Provider Demographics
NPI:1699986612
Name:DAVIS, BARRY C (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BARRY
Other - Middle Name:C
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2402 FRIST BLVD
Mailing Address - Street 2:SUITE 102 & 103
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4838
Mailing Address - Country:US
Mailing Address - Phone:772-465-4651
Mailing Address - Fax:772-465-4087
Practice Address - Street 1:2402 FRIST BLVD
Practice Address - Street 2:SUITE 102 & 103
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4838
Practice Address - Country:US
Practice Address - Phone:772-465-4651
Practice Address - Fax:772-465-4087
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 115367207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0087044000Medicaid
FL0087044000Medicaid