MEDICARE: DR. JAMES H BARRY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35040502B	OH
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	35040502B	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080191711	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000227889	OTHER	OH	ANTHEM
3	45658-0001	OTHER	OH	CARESOURCE
4	633746	OTHER	OH	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	40503-04	OTHER	OH	HUMANA/CHOICECARE

General Provider Information

NPI Number	:	1255334611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES H BARRY M.D.

Provider Business Mailing Address
First Line	:	2912 SPRINGBORO W
Second Line	:	STE 201
City	:	DAYTON
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-297-8996
Fax Number	:	937-396-0045

Provider Business Practice Location Address
First Line	:	78 REMICK BLVD
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-9168
Country	:	US
Telephone Number	:	937-886-9017
Fax Number	:	937-886-9055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/04/2013

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