Provider Demographics
NPI:1427030113
Name:BARRIOS, SERGIO J (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:J
Last Name:BARRIOS
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 1:2360 GAUSE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4141
Mailing Address - Country:US
Mailing Address - Phone:985-641-7283
Mailing Address - Fax:985-641-7218
Practice Address - Street 1:2360 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4141
Practice Address - Country:US
Practice Address - Phone:985-641-7283
Practice Address - Fax:985-641-7218
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14615207RI0011X, 174400000X
LAMD.09182R207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117278Medicaid
LA1963747Medicaid
LA1963747Medicaid
LA060041164Medicare PIN
LA5R577Medicare ID - Type Unspecified
MS060055641Medicare PIN
MS00117278Medicaid