Provider Demographics
NPI:1285600478
Name:BARRY, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:BARRY
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 1:365 TUOLUMNE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5700
Mailing Address - Country:US
Mailing Address - Phone:707-553-5044
Mailing Address - Fax:
Practice Address - Street 1:2031 ANDERSON RD
Practice Address - Street 2:STE A
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-0672
Practice Address - Country:US
Practice Address - Phone:530-757-3700
Practice Address - Fax:530-756-6907
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41905207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8277322Medicaid
CA200005705OtherRAILROAD MEDICARE INDIVIDUAL PTAN
CAE65326Medicare UPIN
CA8277322Medicaid