Provider Demographics
NPI:1215150040
Name:DEFIRMIAN, BARBARA LISA (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LISA
Last Name:DEFIRMIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:BURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0649
Mailing Address - Country:US
Mailing Address - Phone:928-729-8000
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF ROUTE N12 AND N7
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:028-729-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71605207Q00000X
HIMD-14119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000266072OtherHMSA BILLING NUMBER
CA1841217866Medicaid
HI593914-01Medicaid
CAW1508Medicare PIN
CAE37928Medicare UPIN
CA051847Medicare Oscar/Certification
CA1841217866Medicaid