Provider Demographics
NPI:1447296405
Name:EPPLEY, BARRY L (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:L
Last Name:EPPLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11725 N ILLINOIS ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3008
Mailing Address - Country:US
Mailing Address - Phone:317-814-4100
Mailing Address - Fax:317-814-4104
Practice Address - Street 1:11725 N ILLINOIS ST
Practice Address - Street 2:SUITE 140
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3008
Practice Address - Country:US
Practice Address - Phone:317-814-4100
Practice Address - Fax:317-217-2205
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010389762086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200067910Medicaid
IN200067910Medicaid
IN521770HMedicare ID - Type Unspecified