Provider Demographics
NPI:1063457075
Name:BARRE, GREGG MAURICE (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:MAURICE
Last Name:BARRE
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:PO BOX 3780
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3780
Mailing Address - Country:US
Mailing Address - Phone:318-841-9500
Mailing Address - Fax:318-841-9557
Practice Address - Street 1:4801 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6917
Practice Address - Country:US
Practice Address - Phone:337-470-4640
Practice Address - Fax:337-470-4051
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2897207ZP0102X
GA042172207ZP0102X
LA09179R207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189286101Medicaid
LA2R9203OtherMEDICARE PIN
TX8U7847OtherBCBS TX
TX189286103OtherCSHCN
TX189286102Medicaid
TX189286104OtherCSHCN
TX189286101Medicaid
TX189286102Medicaid
TX8F4243Medicare PIN