1568488997 NPI number — YVONNE BARRY MD LTD

Table of content: (NPI 1568488997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568488997 NPI number — YVONNE BARRY MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YVONNE BARRY MD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568488997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 VILLAGE CENTER CIR
Provider Second Line Business Mailing Address:
#3-862
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89134-6238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-924-7006
Provider Business Mailing Address Fax Number:
702-924-7080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7398 SMOKE RANCH RD
Provider Second Line Business Practice Location Address:
#210
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-0256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-924-7006
Provider Business Practice Location Address Fax Number:
702-924-7080
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARRY
Authorized Official First Name:
YVONNE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-924-7006

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  7600 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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