Provider Demographics
NPI:1124004353
Name:BARRICK, STEVEN J (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:BARRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PRO RODEO DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2334
Mailing Address - Country:US
Mailing Address - Phone:719-522-0707
Mailing Address - Fax:719-262-9495
Practice Address - Street 1:104 PRO RODEO DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2334
Practice Address - Country:US
Practice Address - Phone:719-522-0707
Practice Address - Fax:719-262-9495
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01280742Medicaid
COB18058Medicare UPIN
CO01280742Medicaid