Provider Demographics
NPI:1992841860
Name:BAROS, LARRY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WAYNE
Last Name:BAROS
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 1:19276 STONE OAK PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3379
Mailing Address - Country:US
Mailing Address - Phone:210-494-7172
Mailing Address - Fax:210-494-7562
Practice Address - Street 1:19276 STONE OAK PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3378
Practice Address - Country:US
Practice Address - Phone:210-494-7172
Practice Address - Fax:210-494-7562
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG-4813174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4056348OtherAETNA HEALTHCARE
TX86M592OtherBLUE CROSS BLUE SHIELD
TX86M592OtherBLUE CROSS BLUE SHIELD
TX86M592OtherBLUE CROSS BLUE SHIELD
TX00J03AMedicare ID - Type Unspecified