Provider Demographics
NPI:1538182340
Name:GUSTIN, BARRY E (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:E
Last Name:GUSTIN
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 1:3070 KIRK ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3970
Mailing Address - Country:US
Mailing Address - Phone:510-719-8300
Mailing Address - Fax:
Practice Address - Street 1:3070 KIRK ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-3970
Practice Address - Country:US
Practice Address - Phone:510-719-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52596207P00000X
FLME152035207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52302Medicare UPIN