Provider Demographics
NPI:1265451595
Name:BARB, JOHN ELY JR (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ELY
Last Name:BARB
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5334 MEADOW LANE CT
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1469
Mailing Address - Country:US
Mailing Address - Phone:440-934-8921
Mailing Address - Fax:440-934-8938
Practice Address - Street 1:5172 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053
Practice Address - Country:US
Practice Address - Phone:440-282-7420
Practice Address - Fax:440-282-8614
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34.002015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE00578Medicare UPIN
OHBA0366003Medicare PIN