Provider Demographics
NPI:1215939764
Name:FIRSTENBERG, BARRY ALAN (DO)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:ALAN
Last Name:FIRSTENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911242
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1242
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:1631 LANCASTER DR STE 150
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3586
Practice Address - Country:US
Practice Address - Phone:817-251-9080
Practice Address - Fax:817-251-9082
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6294207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115782814Medicaid
TX115782813Medicaid
TX115782812Medicaid
TX115782811Medicaid
TX115782805Medicaid
TX882010Medicare ID - Type UnspecifiedCMS
TX115782807Medicaid
TX8L23394Medicare PIN
A66379Medicare UPIN
TX8L23393Medicare PIN