Healthcare Provider Details

I. General information

NPI: 1407904303
Provider Name (Legal Business Name): BARRY H. STANDLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 SEVILLA AVE NW
ALBUQUERQUE NM
87120-1832
US

IV. Provider business mailing address

5012 SEVILLA AVE NW
ALBUQUERQUE NM
87120-1832
US

V. Phone/Fax

Practice location:
  • Phone: 505-839-3860
  • Fax:
Mailing address:
  • Phone: 505-839-3860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC42541
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number82-132
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: