Provider Demographics
NPI:1144203035
Name:BARRACO, DENNIS A (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:BARRACO
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 1:34522 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE D 8 #614
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-4284
Mailing Address - Country:US
Mailing Address - Phone:480-595-1016
Mailing Address - Fax:480-595-1019
Practice Address - Street 1:520 ROSE LN
Practice Address - Street 2:WICKENBURG REGIONAL MED CENTER
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1447
Practice Address - Country:US
Practice Address - Phone:928-684-5421
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2099207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3981220OtherEVERCARE GROUP #
AZ257106Medicaid
AZAZ02728670OtherBLUE CROSS BLUE SHIELD
AZAW1436OtherHEALTHNET GROUP #
AZ73479Medicare ID - Type Unspecified
AZ257106Medicaid