Provider Demographics
NPI:1124174701
Name:BARBERA, ANTONINO F (MD)
Entity type:Individual
Prefix:
First Name:ANTONINO
Middle Name:F
Last Name:BARBERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16172 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-8959
Mailing Address - Country:US
Mailing Address - Phone:303-667-1735
Mailing Address - Fax:
Practice Address - Street 1:16172 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-8959
Practice Address - Country:US
Practice Address - Phone:303-667-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46361207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08457867Medicaid
CO8457867Medicare PIN
CO08457867Medicaid