Healthcare Provider Details

I. General information

NPI: 1114938065
Provider Name (Legal Business Name): RON BARRETT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 N HALL ST SUITE 400
DALLAS TX
75226-1339
US

IV. Provider business mailing address

PO BOX 660080
DALLAS TX
75266-0080
US

V. Phone/Fax

Practice location:
  • Phone: 214-826-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00824
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: