Provider Demographics
NPI:1477662617
Name:BARRY, WESLEY HENRY JR (MD,)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:HENRY
Last Name:BARRY
Suffix:JR
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 1:1722 PINE STREET
Mailing Address - Street 2:SUITE 904
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1112
Mailing Address - Country:US
Mailing Address - Phone:334-265-9225
Mailing Address - Fax:334-265-9257
Practice Address - Street 1:1722 PINE STREET
Practice Address - Street 2:SUITE 904
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1112
Practice Address - Country:US
Practice Address - Phone:334-265-9225
Practice Address - Fax:334-265-9257
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00011082208600000X
ALMD.11082208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000026092Medicare ID - Type Unspecified
ALC70583Medicare UPIN
C70583Medicare UPIN