Provider Demographics
NPI:1417082892
Name:FENTON, BARRY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JAY
Last Name:FENTON
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 1:6229 DILBECK LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5315
Mailing Address - Country:US
Mailing Address - Phone:972-726-9590
Mailing Address - Fax:
Practice Address - Street 1:3710 RAWLINS ST
Practice Address - Street 2:SUITE 1370
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4217
Practice Address - Country:US
Practice Address - Phone:214-520-7575
Practice Address - Fax:214-520-7579
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG10052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0847220-01Medicaid
TX88W440Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
TXB87761Medicare UPIN