Healthcare Provider Details

I. General information

NPI: 1376501932
Provider Name (Legal Business Name): BARRY N FLANDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 GARNER FIELD RD
UVALDE TX
78801
US

IV. Provider business mailing address

PO BOX 2887
PORT ARTHUR TX
77643-2887
US

V. Phone/Fax

Practice location:
  • Phone: 830-278-6521
  • Fax: 830-278-8529
Mailing address:
  • Phone: 866-808-1556
  • Fax: 409-724-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG7515
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: