Basic Information
| Provider Information | |||||||||
| NPI: | 1144203035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRACO | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34522 N SCOTTSDALE RD | ||||||||
| Address2: | SUITE D 8 #614 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852624284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805951016 | ||||||||
| FaxNumber: | 4805951019 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 ROSE LN | ||||||||
| Address2: | WICKENBURG REGIONAL MED CENTER | ||||||||
| City: | WICKENBURG | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853901447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286845421 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2099 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3981220 | 01 | AZ | EVERCARE GROUP # | OTHER | 257106 | 05 | AZ | MEDICAID | AZ02728670 | 01 | AZ | BLUE CROSS BLUE SHIELD | OTHER | AW1436 | 01 | AZ | HEALTHNET GROUP # | OTHER |