Provider Demographics
NPI:1700885225
Name:BARTH, STEPHEN H (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:BARTH
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 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2155
Mailing Address - Fax:305-500-2155
Practice Address - Street 1:4254 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-2469
Practice Address - Country:US
Practice Address - Phone:361-853-4191
Practice Address - Fax:361-853-8768
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9061207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0348716-01Medicaid
TXC13221Medicare UPIN
TX0348716-01Medicaid