Provider Demographics
NPI:1427490754
Name:LISHA BARRE, MD LLC
Entity type:Organization
Organization Name:LISHA BARRE, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-431-0755
Mailing Address - Street 1:PO BOX 17637
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-0637
Mailing Address - Country:US
Mailing Address - Phone:303-431-0755
Mailing Address - Fax:303-431-0848
Practice Address - Street 1:7850 VANCE DR STE 255
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2103
Practice Address - Country:US
Practice Address - Phone:303-431-0755
Practice Address - Fax:303-474-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO416222081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC806803Medicare PIN
CO12216Medicare UPIN