Provider Demographics
NPI:1508978370
Name:BARRY-PRATHER, ELEANORE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANORE
Middle Name:A
Last Name:BARRY-PRATHER
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 1:110 E APACHE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6902
Mailing Address - Country:US
Mailing Address - Phone:505-564-7903
Mailing Address - Fax:
Practice Address - Street 1:110 E APACHE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6902
Practice Address - Country:US
Practice Address - Phone:505-564-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM004695OtherNM BS
110731579OtherRRM CARE
110731579OtherRRM CARE
NMZ6396Medicaid