Provider Demographics
NPI:1932135977
Name:EWELL, BARRY (DO)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:EWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2000
Mailing Address - Fax:702-383-3620
Practice Address - Street 1:1800 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-383-2000
Practice Address - Fax:702-383-3620
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012913207L00000X
NV1320207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1932135977Medicaid
LA1346802Medicaid
CO21888027OtherOUT OF STATE MEDICAID
AZ260887Medicaid
UT1932135977Medicaid
MO209919208Medicaid
CAXPY206615Medicaid
TX18269989OtherOUT OF STATE MEDICAID
NV1932135977Medicaid
UT1932135977Medicaid