Provider Demographics
NPI:1235131855
Name:BARRY, ROBERT L (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:BARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2345
Mailing Address - Country:US
Mailing Address - Phone:231-392-0421
Mailing Address - Fax:
Practice Address - Street 1:1293 E PARKDALE AVE STE 2300-B
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660
Practice Address - Country:US
Practice Address - Phone:231-398-1735
Practice Address - Fax:231-398-1736
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB056400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI612951200OtherDEPARTMENT OF LABOR
MI700E110080OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MIP00452335OtherRAILROAD MEDICARE
MI4914854Medicaid
MI4914854Medicaid
MIE16002096Medicare PIN