Doctor Name: | DR. BARRYTON DECRUSE WAANBAH |
NPI Number: | 1962790808 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 4301098377 |
Business Practice Address: | 2955 Se 3rd Ct Ocala, FL - 344710441 |
Business Phone Number: | 3525099900 |
Business Fax Number: | 3523510295 |
Mailing Address: | Po Box 4590, OCALA |
State: | FL |
Postal Code: | 344784590 |
Phone Number: | 3525099900 |
Fax Number: | 3523510295 |
NPI Enumeration Date: | 07/12/2011 |
NPI Last Update Date: | 05/06/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 4301098377 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |