Basic Information
Provider Information
NPI: 1144319088
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FESTOFF
FirstName: BARRY
MiddleName: WILLIAM
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4801 E LINWOOD BLVD
Address2: VA MEDICAL CENTER
City: KANSAS CITY
State: MO
PostalCode: 641282226
CountryCode: US
TelephoneNumber: 8168614700
FaxNumber: 8169223375
Practice Location
Address1: 4801 E LINWOOD BLVD
Address2: VA MEDICAL CENTER
City: KANSAS CITY
State: MO
PostalCode: 641282226
CountryCode: US
TelephoneNumber: 8168614700
FaxNumber: 8169223375
Other Information
ProviderEnumerationDate: 10/11/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XR6A37MOY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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