Healthcare Provider Details

I. General information

NPI: 1780144386
Provider Name (Legal Business Name): JEREMY BARR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 BEE CAVES RD UNIT 100
AUSTIN TX
78746-6047
US

IV. Provider business mailing address

5700 GROVER AVE UNIT 1252
AUSTIN TX
78756-1537
US

V. Phone/Fax

Practice location:
  • Phone: 512-401-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberV6863
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: