Healthcare Provider Details

I. General information

NPI: 1295967289
Provider Name (Legal Business Name): RICHARD J BARRY MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 ANDERSON RD STE A
DAVIS CA
95616-0621
US

IV. Provider business mailing address

2031 ANDERSON RD STE A
DAVIS CA
95616-0621
US

V. Phone/Fax

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

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: MR. CHRISTOPHER G TAYLOR
Title or Position: ADMINISTRATOR
Credential: CMPE
Phone: 530-747-5318