Basic Information
| Provider Information | |||||||||
| NPI: | 1710181540 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE BARRANCO CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 E LAKE HOWARD DR | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338813155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632991251 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1397 WHISPER CIR | ||||||||
| Address2: | |||||||||
| City: | SEBRING | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338701205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8633824800 | ||||||||
| FaxNumber: | 8633820761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 04/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | BRIGGS | ||||||||
| AuthorizedOfficialFirstName: | DEANE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8632991251 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.