Provider Demographics
NPI:1053516294
Name:MOSSMAN, BARRY MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:MICHAEL
Last Name:MOSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 MEMORIAL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6723
Mailing Address - Country:US
Mailing Address - Phone:618-474-1723
Mailing Address - Fax:618-474-6988
Practice Address - Street 1:2 MEMORIAL DR
Practice Address - Street 2:STE 220
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6723
Practice Address - Country:US
Practice Address - Phone:618-474-1723
Practice Address - Fax:618-474-6989
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-120094207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine