Provider Demographics
NPI:1083647200
Name:RAYBURN, BARRY KENNEDY (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:KENNEDY
Last Name:RAYBURN
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 1:810 SAINT VINCENTS DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1601
Mailing Address - Country:US
Mailing Address - Phone:205-558-3484
Mailing Address - Fax:205-930-2158
Practice Address - Street 1:2700 10TH AVE S STE 305
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1248
Practice Address - Country:US
Practice Address - Phone:205-939-7100
Practice Address - Fax:205-939-7100
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101272859207RA0001X
ALMD.21024207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE33965OtherVIVA
AL41301OtherHEALTHSPRING OF ALABAMA
AL41301OtherHEALTHSPRING OF ALABAMA