Provider Demographics
NPI:1023095874
Name:BARRY, JOHN SUTHERLAND (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SUTHERLAND
Last Name:BARRY
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 1:1111 HIGHWAY 73
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767
Mailing Address - Country:US
Mailing Address - Phone:218-565-6283
Mailing Address - Fax:651-431-7631
Practice Address - Street 1:1111 HIGHWAY 73
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767
Practice Address - Country:US
Practice Address - Phone:218-565-6283
Practice Address - Fax:651-431-7631
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN771183200Medicaid