Provider Demographics
NPI:1982654349
Name:HARRE, BARBARA ANN (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:HARRE
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 1:1230 E RUSHOLME ST
Mailing Address - Street 2:BLDG. 2 LL 01
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2400
Mailing Address - Country:US
Mailing Address - Phone:563-421-7160
Mailing Address - Fax:563-421-7161
Practice Address - Street 1:1230 E RUSHOLME ST
Practice Address - Street 2:BLDG. 2 LL 01
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2400
Practice Address - Country:US
Practice Address - Phone:563-421-7160
Practice Address - Fax:563-421-7161
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26138208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4037960Medicaid
E97426Medicare UPIN
IAI4353Medicare ID - Type Unspecified