Provider Demographics
NPI:1518320779
Name:BARRAZA, MARY C (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:BARRAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:MATTERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 SUZIE LN
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:IN
Mailing Address - Zip Code:47918-2009
Mailing Address - Country:US
Mailing Address - Phone:765-762-6789
Mailing Address - Fax:765-762-6766
Practice Address - Street 1:101 SUZIE LN
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:IN
Practice Address - Zip Code:47918-2009
Practice Address - Country:US
Practice Address - Phone:765-762-6789
Practice Address - Fax:765-762-6766
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01092440A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100614920Medicaid
OH0179526Medicaid