Provider Demographics
NPI:1437171089
Name:BARRIOS, BENNETT R (MD)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:R
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:PO BOX 6951
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0951
Mailing Address - Country:US
Mailing Address - Phone:402-904-7135
Mailing Address - Fax:402-904-7175
Practice Address - Street 1:201 S 68TH STREET PL
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2496
Practice Address - Country:US
Practice Address - Phone:402-327-7300
Practice Address - Fax:402-327-7392
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE217502085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
233831OtherCOVENTRY HEALTH CARE
77063443668510A002OtherTRI WEST
P00223632OtherRAILROAD MEDICARE
NE07104OtherBCBS OF NE
NEG46899Medicare UPIN
77063443668510A002OtherTRI WEST