Provider Demographics
NPI:1366636755
Name:LONSON L BARR, D.O., P.C.
Entity Type:Organization
Organization Name:LONSON L BARR, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LONSON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-246-6262
Mailing Address - Street 1:1945 BOSTON ST SE
Mailing Address - Street 2:STE 303
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4100
Mailing Address - Country:US
Mailing Address - Phone:616-246-6262
Mailing Address - Fax:616-246-8737
Practice Address - Street 1:1945 BOSTON ST SE
Practice Address - Street 2:STE 303
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4100
Practice Address - Country:US
Practice Address - Phone:616-246-6262
Practice Address - Fax:616-246-8737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005711208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1767521Medicaid