=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205015369
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCTAVIO BARRIOS, MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2007
-----------------------------------------------------
Last Update Date | 02/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7106 SPENCER HWY
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77505-1806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-542-9400
-----------------------------------------------------
Fax | 281-542-9461
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 517 W GRAY ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77019-4476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-942-7546
-----------------------------------------------------
Fax | 281-542-9461
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. OCTAVIO BARRIOS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-542-9400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | J4705
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------