Healthcare Provider Details

I. General information

NPI: 1649405622
Provider Name (Legal Business Name): ROBERT TAYLOR BARE BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N. O'CONNOR SUITE 102B
IRVING TX
75062-5698
US

IV. Provider business mailing address

215 SHUMAN BOULEVARD SUITE 401
NAPERVILLE IL
60563-8123
US

V. Phone/Fax

Practice location:
  • Phone: 972-252-9360
  • Fax: 972-252-7516
Mailing address:
  • Phone: 630-303-5380
  • Fax: 630-303-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number10747
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: