Healthcare Provider Details

I. General information

NPI: 1639717614
Provider Name (Legal Business Name): ROBERT BARRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 CELEBRATION DR NE
GRAND RAPIDS MI
49525-9200
US

IV. Provider business mailing address

14301 FAA BLVD STE 105
FORT WORTH TX
76155-2520
US

V. Phone/Fax

Practice location:
  • Phone: 616-287-6005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: