Provider Demographics
NPI:1205908639
Name:ZEFFREN, BARRY F (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:F
Last Name:ZEFFREN
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 1:4 COUNTRY CLUB EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034
Mailing Address - Country:US
Mailing Address - Phone:618-288-6673
Mailing Address - Fax:618-288-1938
Practice Address - Street 1:4 COUNTRY CLUB EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034
Practice Address - Country:US
Practice Address - Phone:618-288-6673
Practice Address - Fax:618-288-1938
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068207207K00000X
MOR8A32207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45997Medicare UPIN
ILL31085Medicare PIN