Provider Demographics
NPI:1316032261
Name:BARR, DELAND RAY (DO)
Entity Type:Individual
Prefix:
First Name:DELAND
Middle Name:RAY
Last Name:BARR
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:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-0002
Mailing Address - Country:US
Mailing Address - Phone:208-549-3654
Mailing Address - Fax:
Practice Address - Street 1:683 E 3RD ST
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-2248
Practice Address - Country:US
Practice Address - Phone:208-549-0211
Practice Address - Fax:208-549-0104
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0-116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID004309900Medicaid
C60019Medicare UPIN
1301123Medicare ID - Type Unspecified
ID004309900Medicaid
ID1301129Medicare PIN
ID010051831Medicare PIN
1301129Medicare ID - Type Unspecified