Provider Demographics
NPI:1104910272
Name:TROUTMAN, BARRY DON (DO)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:DON
Last Name:TROUTMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4619 S HARVARD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2921
Mailing Address - Country:US
Mailing Address - Phone:918-747-0900
Mailing Address - Fax:918-747-0980
Practice Address - Street 1:4619 S HARVARD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2920
Practice Address - Country:US
Practice Address - Phone:918-747-0900
Practice Address - Fax:918-747-0980
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100129870AMedicaid
OKG13703Medicare UPIN