Provider Demographics
NPI:1689618613
Name:BARR, THEODORE GRAHAM (PA-C)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:GRAHAM
Last Name:BARR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4250
Mailing Address - Country:US
Mailing Address - Phone:253-403-7257
Mailing Address - Fax:253-403-1340
Practice Address - Street 1:314 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4250
Practice Address - Country:US
Practice Address - Phone:253-403-7257
Practice Address - Fax:253-403-1340
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant