Provider Demographics
NPI:1720082217
Name:MINK, BARRY (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:MINK
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 1:100 E MAIN ST
Mailing Address - Street 2:201
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611
Mailing Address - Country:US
Mailing Address - Phone:970-544-1131
Mailing Address - Fax:
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1778
Practice Address - Country:US
Practice Address - Phone:970-544-1131
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01183839Medicaid
CO69914Medicare ID - Type Unspecified
CO01183839Medicaid