Provider Demographics
NPI:1417952888
Name:BARRY, RONALD C
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:C
Last Name:BARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4677 TOWNE CTR
Mailing Address - Street 2:STE 105
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2847
Mailing Address - Country:US
Mailing Address - Phone:989-791-1634
Mailing Address - Fax:989-791-0428
Practice Address - Street 1:4677 TOWNE CTR
Practice Address - Street 2:STE 105
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2847
Practice Address - Country:US
Practice Address - Phone:989-791-1634
Practice Address - Fax:989-791-0428
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048769208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2407308761OtherBLUE CROSS BLUE SHIELD
MI2745420Medicaid
MI2745420Medicaid
MI0P28850Medicare PIN