Provider Demographics
NPI:1932307188
Name:BARR, LUCY JANE (MD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:JANE
Last Name:BARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 S 1100 E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1686
Mailing Address - Country:US
Mailing Address - Phone:801-355-3404
Mailing Address - Fax:801-532-0205
Practice Address - Street 1:82 S 1100 E
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1686
Practice Address - Country:US
Practice Address - Phone:801-355-3404
Practice Address - Fax:801-532-0205
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP3792082S0099X
OH350895612082S0099X
CO454822082S0099X
UT54160868905207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000064118OtherMEDICARE PTAN
UT1932367976Medicaid