Provider Demographics
NPI:1699805333
Name:SMITH, BARRY JOE (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:JOE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 822344
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-2344
Mailing Address - Country:US
Mailing Address - Phone:314-308-2799
Mailing Address - Fax:908-653-9305
Practice Address - Street 1:12345 W BEND DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2182
Practice Address - Country:US
Practice Address - Phone:314-722-2530
Practice Address - Fax:314-722-2534
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2014-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO116656207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO116656OtherMEDICAL LICENSE
MOF85720Medicare UPIN