Provider Demographics
NPI:1770648057
Name:MOULTON-BARRETT, REX EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:EDWARD
Last Name:MOULTON-BARRETT
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 1:2070 CLINTON AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4399
Mailing Address - Country:US
Mailing Address - Phone:510-864-1800
Mailing Address - Fax:510-864-1180
Practice Address - Street 1:2070 CLINTON AVE FL 4
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4399
Practice Address - Country:US
Practice Address - Phone:510-864-1800
Practice Address - Fax:510-864-1180
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45787174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty