Provider Demographics
NPI:1750352183
Name:NORTHCUTT, BARRY L (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:NORTHCUTT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9800 BROADWAY EXTENSION
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114
Mailing Address - Country:US
Mailing Address - Phone:405-340-4744
Mailing Address - Fax:405-677-8319
Practice Address - Street 1:9800 BROADWAY EXTENSION
Practice Address - Street 2:SUITE 201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114
Practice Address - Country:US
Practice Address - Phone:405-340-4744
Practice Address - Fax:405-677-8319
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2016-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK18467207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG67539Medicare UPIN
OK245505303Medicare PIN
OK100131590AMedicaid
OKP00341350OtherRAILROAD MEDICARE