Provider Demographics
NPI:1750318341
Name:ROSENBLUM, BARRY N (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:N
Last Name:ROSENBLUM
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 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-996-4790
Mailing Address - Fax:314-996-4792
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE 351C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-996-4790
Practice Address - Fax:314-996-4792
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1E76207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507396109Medicaid
MO000095555Medicare ID - Type Unspecified
MO507396109Medicaid