Healthcare Provider Details

I. General information

NPI: 1164591608
Provider Name (Legal Business Name): ROBERT S BARRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S MILLER ST
SANTA MARIA CA
93454-6959
US

IV. Provider business mailing address

1420 S MILLER ST
SANTA MARIA CA
93454-6959
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-3573
  • Fax: 805-922-7972
Mailing address:
  • Phone: 805-922-3573
  • Fax: 805-922-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberGO62473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: