Healthcare Provider Details

I. General information

NPI: 1255326534
Provider Name (Legal Business Name): PATRICK CHARLES BARRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CR 804 STE 210 FRASER MEDICAL CLINIC
FRASER CO
80442-0386
US

IV. Provider business mailing address

PO BOX 3550 FRASER MEDICAL CLINIC
WINTER PARK CO
80482-3550
US

V. Phone/Fax

Practice location:
  • Phone: 970-726-6778
  • Fax: 970-726-2474
Mailing address:
  • Phone: 970-726-6778
  • Fax: 970-726-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36188
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: