Healthcare Provider Details

I. General information

NPI: 1659343309
Provider Name (Legal Business Name): MICHAEL BARRY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1307
  • Fax:
Mailing address:
  • Phone: 760-725-1307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102201496
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: