Provider Demographics
NPI:1265466262
Name:DINER, BARRY M (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:M
Last Name:DINER
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 1:6750 WEST LOOP S
Mailing Address - Street 2:SUITE 950
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4103
Mailing Address - Country:US
Mailing Address - Phone:713-838-0800
Mailing Address - Fax:
Practice Address - Street 1:6750 WEST LOOP S
Practice Address - Street 2:SUITE 950
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4103
Practice Address - Country:US
Practice Address - Phone:713-838-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA531134207P00000X
TXM9976207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198933703Medicaid
TX198933701Medicaid
TXP00667177Medicare Oscar/Certification
TX8L18902Medicare Oscar/Certification
TX198933701Medicaid