Basic Information
| Provider Information | |||||||||
| NPI: | 1376501932 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLANDERS | ||||||||
| FirstName: | BARRY | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2887 | ||||||||
| Address2: | |||||||||
| City: | PORT ARTHUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776432887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668081556 | ||||||||
| FaxNumber: | 4097240214 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 GARNER FIELD RD | ||||||||
| Address2: | |||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302786521 | ||||||||
| FaxNumber: | 8302788529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 02/17/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | G7515 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 126403801 | 05 | TX | MEDICAID | 126403806 | 05 | TX | MEDICAID | 00F06R | 01 | TX | BCBS | OTHER | P00995414 | 01 | TX | RAILROAD | OTHER |