Provider Demographics
NPI:1558568493
Name:BARRY, TIMOTHY P (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:P
Last Name:BARRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 W 2ND ST STE C
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3240
Mailing Address - Country:US
Mailing Address - Phone:812-481-7200
Mailing Address - Fax:812-481-7201
Practice Address - Street 1:695 W 2ND ST STE C
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3240
Practice Address - Country:US
Practice Address - Phone:812-481-7200
Practice Address - Fax:812-481-7201
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001046A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery