Provider Demographics
NPI:1760453088
Name:BARR, RAYANN E (PA)
Entity Type:Individual
Prefix:
First Name:RAYANN
Middle Name:E
Last Name:BARR
Suffix:
Gender:F
Credentials:PA
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 11840
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-1840
Mailing Address - Country:US
Mailing Address - Phone:541-677-4313
Mailing Address - Fax:541-677-4533
Practice Address - Street 1:1460 G ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4112
Practice Address - Country:US
Practice Address - Phone:541-677-4313
Practice Address - Fax:541-677-4533
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00669363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPA00669OtherSTATE LICENSE
OR970016302OtherRAILROAD MEDICARE #
OR217562Medicaid
ORS83736Medicare UPIN
OR217562Medicaid
OR970016302OtherRAILROAD MEDICARE #