Provider Demographics
NPI:1831223890
Name:WASHINGTON, BARRY (IDC)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS DEWERT FFG 45
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:34090-1499
Mailing Address - Country:US
Mailing Address - Phone:904-270-5947
Mailing Address - Fax:
Practice Address - Street 1:USS DE WERT FFG 45
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:34090
Practice Address - Country:US
Practice Address - Phone:904-270-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman