Provider Demographics
NPI:1093803918
Name:BARAHAL, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BARAHAL
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 1:111 W 2ND ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2454
Mailing Address - Country:US
Mailing Address - Phone:307-237-5848
Mailing Address - Fax:307-237-5848
Practice Address - Street 1:111 W 2ND ST
Practice Address - Street 2:SUITE 415
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2454
Practice Address - Country:US
Practice Address - Phone:307-237-5848
Practice Address - Fax:307-237-5848
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6452A207L00000X, 170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115884800Medicaid