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General NPI Number Information
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NPI Number | 1164519849
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Entity Type | Individual
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Provider Name | BARRY L FUNKHOUSER MD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 301 ANDREWS AVENUE
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City | FORT RUCKER
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State | AL
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Zip | 36362
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Country | US
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Telephone | 334-255-7387
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Fax | 334-255-7716
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Provider Business Mailing Address
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Address Line | 117 VIXEN CT
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City | DOTHAN
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State | AL
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Zip | 36305-9353
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Country | US
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Telephone | 334-699-8516
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 928
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License Number State | AL
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