Basic Information
| Provider Information | |||||||||
| NPI: | 1093710147 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARBOUR | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2350 MIAMI VALLEY DR | ||||||||
| Address2: | SUITE 320 A | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454594778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373121661 | ||||||||
| FaxNumber: | 9373121701 | ||||||||
| Practice Location | |||||||||
| Address1: | 2350 MIAMI VALLEY DR | ||||||||
| Address2: | SUITE 320 A | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454594778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373121661 | ||||||||
| FaxNumber: | 9373121701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 11/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 36002631 | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2124712 | 05 | OH | MEDICAID |