Individual
DR. JEFFREY R BARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5100 LAKE TER NE, SUITE WC, MOUNT VERNON, IL 62864-9665
(618) 899-5001
(618) 242-5152
Mailing address
5100 LAKE TER NE, SUITE WC, MOUNT VERNON, IL 62864-9665
(618) 899-5001
(618) 242-5152
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036107295
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036107295
—
IL
Enumeration date
02/22/2006
Last updated
05/13/2015
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