Provider Demographics
NPI:1275858946
Name:GOMMER, BARRY LEE JR (LAC)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:LEE
Last Name:GOMMER
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1536 KIRKWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5716
Mailing Address - Country:US
Mailing Address - Phone:302-454-1230
Mailing Address - Fax:302-454-5855
Practice Address - Street 1:1536 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5716
Practice Address - Country:US
Practice Address - Phone:302-454-1230
Practice Address - Fax:302-454-5855
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist