Provider Demographics
NPI:1275039877
Name:BARRY, SAMUEL HIGGINS (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:HIGGINS
Last Name:BARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1104 N VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3094
Mailing Address - Country:US
Mailing Address - Phone:217-442-2631
Mailing Address - Fax:217-442-0119
Practice Address - Street 1:1104 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3094
Practice Address - Country:US
Practice Address - Phone:217-442-2631
Practice Address - Fax:217-442-0119
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0093855207W00000X
MO2023012406207W00000X
IL036173314207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology