Provider Demographics
NPI:1063627115
Name:MANGUS, BARRY E (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:E
Last Name:MANGUS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1333 W 5TH STREET
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801
Mailing Address - Country:US
Mailing Address - Phone:307-673-3181
Mailing Address - Fax:307-673-3180
Practice Address - Street 1:1333 W 5TH STREET
Practice Address - Street 2:SUITE #200
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801
Practice Address - Country:US
Practice Address - Phone:307-673-3181
Practice Address - Fax:307-673-3180
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2021-05-11
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Provider Licenses
StateLicense IDTaxonomies
WY7728A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW21836Medicare PIN