Provider Demographics
NPI:1245264688
Name:BARRETT, JOHN WILLARD (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLARD
Last Name:BARRETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 KINGSTOWN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3239
Mailing Address - Country:US
Mailing Address - Phone:401-783-3334
Mailing Address - Fax:401-783-9270
Practice Address - Street 1:360 KINGSTOWN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3239
Practice Address - Country:US
Practice Address - Phone:401-783-3334
Practice Address - Fax:401-783-9270
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003613Medicaid
RI9003613Medicaid
RIC90280Medicare UPIN