Provider Demographics
NPI:1386671204
Name:BARRIS, MICHAEL S (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:BARRIS
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 1:6250 REGIONAL PLZ STE 1060
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5261
Mailing Address - Country:US
Mailing Address - Phone:325-428-5660
Mailing Address - Fax:833-707-2341
Practice Address - Street 1:6250 REGIONAL PLZ STE 1060
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5261
Practice Address - Country:US
Practice Address - Phone:325-428-5660
Practice Address - Fax:833-707-2341
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31361207Q00000X
TXR7658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01313618Medicaid
TX392206401Medicaid
COCR9028Medicare PIN