Provider Demographics
NPI:1356542245
Name:BARRE, ABDUSELAM HUSSEIN (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUSELAM
Middle Name:HUSSEIN
Last Name:BARRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2130 HERITAGE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-7800
Mailing Address - Country:US
Mailing Address - Phone:805-296-7819
Mailing Address - Fax:805-239-1279
Practice Address - Street 1:2130 HERITAGE LOOP RD
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-7800
Practice Address - Country:US
Practice Address - Phone:805-296-7819
Practice Address - Fax:805-239-1279
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G727450Medicaid
CA00G727450Medicaid
CACA945ZMedicare PIN