Basic Information
| Provider Information | |||||||||
| NPI: | 1073700969 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARBER | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | RALPH | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 S SHERWOOD FOREST BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708166038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257657735 | ||||||||
| FaxNumber: | 2257659196 | ||||||||
| Practice Location | |||||||||
| Address1: | 7777 HENNESSY BLVD STE 709 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257657735 | ||||||||
| FaxNumber: | 2257659937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 06/30/2020 | ||||||||
| NPIReactivationDate: | 01/13/2021 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | R76064 | AZ | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YX0602X | 331171 | LA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngic Allergy |
ID Information
| ID | Type | State | Issuer | Description | 331171 | 01 | LA | STATE LICENSE | OTHER |