Healthcare Provider Details

I. General information

NPI: 1073700969
Provider Name (Legal Business Name): SAMUEL RALPH BARBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date: 06/30/2020
Reactivation Date: 01/13/2021

III. Provider practice location address

2910 N 3RD AVE # 330
PHOENIX AZ
85013-4434
US

IV. Provider business mailing address

240 W THOMAS RD STE 301
PHOENIX AZ
85013-4407
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-8811
  • Fax: 602-406-8810
Mailing address:
  • Phone: 602-406-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberR76064
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number331171
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number72109
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: