Provider Demographics
NPI:1598869091
Name:BARRY, TODD S (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:S
Last Name:BARRY
Suffix:
Gender:M
Credentials:MD, PHD
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 1000
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0071
Mailing Address - Country:US
Mailing Address - Phone:541-770-4559
Mailing Address - Fax:541-770-4511
Practice Address - Street 1:213 TECHNOLOGY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2437
Practice Address - Country:US
Practice Address - Phone:949-637-8633
Practice Address - Fax:949-208-9790
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035593174400000X
ORMD169999207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH81778Medicare UPIN
WAGAB36774Medicare PIN