Healthcare Provider Details

I. General information

NPI: 1508886474
Provider Name (Legal Business Name): ROBERT B BARBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

350 JH WALKER DR SUITE 100
PENDLETON IN
46064-8750
US

V. Phone/Fax

Practice location:
  • Phone: 317-554-0000
  • Fax:
Mailing address:
  • Phone: 765-778-7509
  • Fax: 765-778-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number01065341A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number1065341A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: