Healthcare Provider Details

I. General information

NPI: 1144203035
Provider Name (Legal Business Name): DENNIS A BARRACO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 ROSE LN WICKENBURG REGIONAL MED CENTER
WICKENBURG AZ
85390-1447
US

IV. Provider business mailing address

34522 N SCOTTSDALE RD SUITE D 8 #614
SCOTTSDALE AZ
85262-4284
US

V. Phone/Fax

Practice location:
  • Phone: 928-684-5421
  • Fax:
Mailing address:
  • Phone: 480-595-1016
  • Fax: 480-595-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2099
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: