Provider Demographics
NPI:1720020357
Name:BARREY, ROGER LOREN (PAC)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:LOREN
Last Name:BARREY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W BROADWAY
Mailing Address - Street 2:STE 310
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4012
Mailing Address - Country:US
Mailing Address - Phone:406-728-6520
Mailing Address - Fax:406-329-2936
Practice Address - Street 1:500 W BROADWAY
Practice Address - Street 2:STE 310
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4012
Practice Address - Country:US
Practice Address - Phone:406-728-6520
Practice Address - Fax:406-329-2936
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT95363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000900763OtherBCBS
MT1720020357Medicaid
MTR81178Medicare UPIN
MT0000900763OtherBCBS
MT5482060001Medicare NSC