Provider Demographics
NPI:1932516473
Name:BARROW, CORY (NAVY IDC)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:BARROW
Suffix:
Gender:M
Credentials:NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2846 FALVY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5811
Mailing Address - Country:US
Mailing Address - Phone:909-224-1056
Mailing Address - Fax:
Practice Address - Street 1:200 MERCY COURT
Practice Address - Street 2:
Practice Address - City:CAMP PENDLETON SOUTH
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:909-224-1056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB-300-00191710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman