Provider Demographics
NPI:1902839087
Name:RAPP, BARRY M (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:M
Last Name:RAPP
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 1:1600 N GRAND AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2755
Mailing Address - Country:US
Mailing Address - Phone:719-595-7700
Mailing Address - Fax:719-595-7719
Practice Address - Street 1:1600 N GRAND AVE STE 150
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2755
Practice Address - Country:US
Practice Address - Phone:719-595-7700
Practice Address - Fax:719-595-7719
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01177724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO444388Medicare ID - Type Unspecified
COD23341Medicare UPIN