Healthcare Provider Details

I. General information

NPI: 1518046077
Provider Name (Legal Business Name): STEPHEN ELDRIDGE BARR L.AC., DIPL.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 WEST LAKE BLVD. SUITE 3
TAHOE CITY CA
96145
US

IV. Provider business mailing address

PO BOX 7696
TAHOE CITY CA
96145-7696
US

V. Phone/Fax

Practice location:
  • Phone: 530-583-9407
  • Fax: 530-583-0543
Mailing address:
  • Phone: 530-583-9407
  • Fax: 530-583-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCA 1139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: