Provider Demographics
NPI:1295967289
Name:RICHARD J BARRY MD
Entity type:Organization
Organization Name:RICHARD J BARRY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:530-747-5318
Mailing Address - Street 1:2031 ANDERSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0621
Mailing Address - Country:US
Mailing Address - Phone:530-757-3700
Mailing Address - Fax:530-756-6907
Practice Address - Street 1:2031 ANDERSON RD STE A
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-0621
Practice Address - Country:US
Practice Address - Phone:530-757-3700
Practice Address - Fax:530-756-6907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41905207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00C419050Medicare PIN
E65326Medicare UPIN