MEDICARE: RAYANN E. BARR P.A.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA00669	OR
2	363A00000X	Physician Assistant	PA00669	OR

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	970016302	OTHER	OR	RAILROAD MEDICARE #

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA00669	OTHER	OR	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1760453088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYANN E. BARR P.A.

Provider Business Mailing Address
First Line	:	PO BOX 11840
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92685-1840
Country	:	US
Telephone Number	:	541-677-4313
Fax Number	:	541-677-4533

Provider Business Practice Location Address
First Line	:	1460 G ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-4112
Country	:	US
Telephone Number	:	541-677-4313
Fax Number	:	541-677-4533

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	05/22/2008

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039