Provider Demographics
NPI:1639193766
Name:WILLIAMS, BARRY RALPH (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:RALPH
Last Name:WILLIAMS
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 1:858 EASTERN BYP
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2512
Mailing Address - Country:US
Mailing Address - Phone:859-626-0072
Mailing Address - Fax:859-626-9684
Practice Address - Street 1:858 EASTERN BYP
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2512
Practice Address - Country:US
Practice Address - Phone:859-626-0072
Practice Address - Fax:859-626-9684
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38492208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4000501OtherMEDICARE LAB GRP
KY37903705OtherMEDICAID LAB GRP
KY64089824Medicaid
KY0326322Medicare ID - Type Unspecified
KY0092734Medicare PIN
KY64089824Medicaid
I06253Medicare UPIN