MEDICARE: DICK BARLOW MDPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0602X	Otolaryngic Allergy Physician	D4906	TX

General Provider Information

NPI Number	:	1255590618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DICK BARLOW MDPA

Provider Business Mailing Address
First Line	:	2935 PARK PLAZA LN
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5516
Country	:	US
Telephone Number	:	409-985-2529
Fax Number	:	409-985-3565

Provider Business Practice Location Address
First Line	:	2935 PARK PLAZA LN
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5516
Country	:	US
Telephone Number	:	409-985-2529
Fax Number	:	409-985-3565

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DICK BARLOW
Credential	:	MD
Telephone Number	:	409-985-2529

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	10/23/2008

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