Provider Demographics
NPI:1730247776
Name:BARRY R. MARFLEET, M.D., INC.
Entity type:Organization
Organization Name:BARRY R. MARFLEET, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARFLEET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-744-4044
Mailing Address - Street 1:1026 E CHAPMAN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2149
Mailing Address - Country:US
Mailing Address - Phone:714-744-4044
Mailing Address - Fax:714-744-2428
Practice Address - Street 1:1026 E CHAPMAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2149
Practice Address - Country:US
Practice Address - Phone:714-744-4044
Practice Address - Fax:714-744-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW9159Medicare PIN
E91357Medicare UPIN