Provider Demographics
NPI:1811936693
Name:UHL, BARRY M (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:M
Last Name:UHL
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 1:5725 KEARNY VILLA RD
Mailing Address - Street 2:STE I
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1134
Mailing Address - Country:US
Mailing Address - Phone:858-256-0351
Mailing Address - Fax:858-256-0355
Practice Address - Street 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:CANCER CENTER
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3019
Practice Address - Country:US
Practice Address - Phone:619-644-4500
Practice Address - Fax:619-644-4547
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA719692085R0001X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA71969OtherMEDICAL LICENSE
CA00A719690Medicaid
CAWA71969EMedicare PIN
CAWA71969IMedicare PIN
CAH16972Medicare UPIN
CA00A719690Medicaid
CAA71969OtherMEDICAL LICENSE
CAWA71969FMedicare ID - Type UnspecifiedGROSSMONT MEDICARE