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NPI Code Detail

MEDICARE: ROGER LOREN BARREY PAC

MEDICARE: ROGER LOREN BARREY PAC
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
1363A00000XPhysician Assistant95MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10000900763OTHERMTBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720020357
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER LOREN BARREY PAC
Provider Business Mailing Address
First Line : 500 W BROADWAY
Second Line : STE 310
City : MISSOULA
State : MT
Zip : 59802-4012
Country : US
Telephone Number : 406-728-6520
Fax Number : 406-329-2936
Provider Business Practice Location Address
First Line : 500 W BROADWAY
Second Line : STE 310
City : MISSOULA
State : MT
Zip : 59802-4012
Country : US
Telephone Number : 406-728-6520
Fax Number : 406-329-2936
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2006
Last Update Date : 04/02/2008

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Directions to “ ROGER LOREN BARREY PAC” Practice Location

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