Provider Demographics
NPI:1417075417
Name:BARRY, YVONNE N (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:N
Last Name:BARRY
Suffix:
Gender:F
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:PO BOX 975190
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-5190
Mailing Address - Country:US
Mailing Address - Phone:281-412-2494
Mailing Address - Fax:281-412-2495
Practice Address - Street 1:14027 MEMORIAL DR
Practice Address - Street 2:SUITE 252
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6826
Practice Address - Country:US
Practice Address - Phone:281-412-2494
Practice Address - Fax:281-412-2495
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG97082080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130257205Medicaid
81K191Medicare ID - Type Unspecified
TX130257205Medicaid