Provider Demographics
NPI:1205829462
Name:JUSTICE, BARRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:JUSTICE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4818 WELLINGTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6010
Mailing Address - Country:US
Mailing Address - Phone:903-455-3261
Mailing Address - Fax:903-455-0211
Practice Address - Street 1:4818 WELLINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6010
Practice Address - Country:US
Practice Address - Phone:903-455-3261
Practice Address - Fax:903-455-0211
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2012-02-09
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Provider Licenses
StateLicense IDTaxonomies
TXG1929208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121469402Medicaid