Healthcare Provider Details

I. General information

NPI: 1558853630
Provider Name (Legal Business Name): RICKY BARBER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OLD TOWNE RD
LOUISVILLE KY
40214-4312
US

IV. Provider business mailing address

401 OLD TOWNE RD
LOUISVILLE KY
40214-4312
US

V. Phone/Fax

Practice location:
  • Phone: 502-407-7326
  • Fax:
Mailing address:
  • Phone: 502-407-7326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: