Provider Demographics
NPI:1073975595
Name:BARRAS, GLENN JOHN III
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:JOHN
Last Name:BARRAS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-4309
Mailing Address - Country:US
Mailing Address - Phone:225-765-5500
Mailing Address - Fax:
Practice Address - Street 1:214 CLINIC DR
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-4309
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD308263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA054069OtherCDS
LA308263OtherSTATE LICENSE
LAFB8180743OtherDEA