Healthcare Provider Details

I. General information

NPI: 1780686592
Provider Name (Legal Business Name): BARRY A LABINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 19TH ST S STE 106
SARTELL MN
56377-2555
US

IV. Provider business mailing address

161 19TH ST S STE 106
SARTELL MN
56377-2555
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-3376
  • Fax: 320-288-2701
Mailing address:
  • Phone: 320-252-3376
  • Fax: 320-288-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35729
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: