Provider Demographics
NPI:1023092673
Name:OSHEROWITZ, BARRY MARVIN (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:MARVIN
Last Name:OSHEROWITZ
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 1:1608 JIMMIE DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4559
Mailing Address - Country:US
Mailing Address - Phone:318-747-2510
Mailing Address - Fax:318-742-3727
Practice Address - Street 1:1608 JIMMIE DAVIS HWY
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4559
Practice Address - Country:US
Practice Address - Phone:318-747-2510
Practice Address - Fax:318-742-3727
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05818R207RG0100X
DCMD10865207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1323292Medicaid
LA1323292Medicaid
LA5K875Medicare ID - Type Unspecified