Provider Demographics
NPI:1093710147
Name:BARBOUR, GREGORY LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEE
Last Name:BARBOUR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2350 MIAMI VALLEY DR
Mailing Address - Street 2:SUITE 320 A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4778
Mailing Address - Country:US
Mailing Address - Phone:937-312-1661
Mailing Address - Fax:937-312-1701
Practice Address - Street 1:2350 MIAMI VALLEY DR
Practice Address - Street 2:SUITE 320 A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4778
Practice Address - Country:US
Practice Address - Phone:937-312-1661
Practice Address - Fax:937-312-1701
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002631213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2124712Medicaid
OHU13478Medicare UPIN
OH2124712Medicaid
OHDI9251311Medicare ID - Type UnspecifiedGROUP# (CENTERVILLE OFFIC
OHDI9251312Medicare ID - Type UnspecifiedGROUP#(VANDALIA LOCATION)
0886607Medicare PIN
OHBA0886601Medicare ID - Type UnspecifiedCENTERVILLE LOCATION