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General NPI Number Information
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NPI Number | 1205105558
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Entity Type | Individual
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Provider Name | JOHN BARRY ROCHE HIS
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Gender | Male
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 1141 E COOLEY ST SUITE T
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City | SHOW LOW
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State | AZ
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Zip | 85901-5103
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Country | US
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Telephone | 192-853-7095
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Fax | 192-835-8123
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Provider Business Mailing Address
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Address Line | 1141 E COOLEY ST SUITE T
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City | SHOW LOW
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State | AZ
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Zip | 85901-5103
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Country | US
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Telephone | 192-853-7095
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Fax | 192-835-8123
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HAD1456
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License Number State | AZ
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