Provider Demographics
NPI:1285625699
Name:PAULL, BARRY R (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:R
Last Name:PAULL
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 1:3306 LONGMIRE DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5812
Mailing Address - Country:US
Mailing Address - Phone:979-485-0571
Mailing Address - Fax:979-485-0575
Practice Address - Street 1:3306 LONGMIRE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5812
Practice Address - Country:US
Practice Address - Phone:979-485-0571
Practice Address - Fax:979-485-0575
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2846207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121182100OtherFIRST CARE
557213OtherUNITED HEALTH CARE
4403117OtherAETNA
TX81Z670OtherBLUE CROSS BLUE SHIELD
97504872OtherCIGNA
TX1155160-02Medicaid
822149OtherFIRST HEALTH
4403117OtherAETNA
C20318Medicare UPIN