Provider Demographics
NPI:1205105558
Name:ROCHE, JOHN BARRY (HIS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BARRY
Last Name:ROCHE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 E COOLEY ST
Mailing Address - Street 2:SUITE T
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-5103
Mailing Address - Country:US
Mailing Address - Phone:192-853-7095
Mailing Address - Fax:192-835-8123
Practice Address - Street 1:1141 E COOLEY ST
Practice Address - Street 2:SUITE T
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5103
Practice Address - Country:US
Practice Address - Phone:192-853-7095
Practice Address - Fax:192-835-8123
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD1456237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist