Healthcare Provider Details

I. General information

NPI: 1285600478
Provider Name (Legal Business Name): RICHARD J BARRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 ANDERSON RD STE A
DAVIS CA
95616-0672
US

IV. Provider business mailing address

365 TUOLUMNE ST
VALLEJO CA
94590-5700
US

V. Phone/Fax

Practice location:
  • Phone: 530-757-3700
  • Fax: 530-756-6907
Mailing address:
  • Phone: 707-553-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberC41905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: