Provider Demographics
NPI:1457612871
Name:MINOR, BARRY W (CP)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:W
Last Name:MINOR
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4140 FERNCREEK DR
Mailing Address - Street 2:SUITE 803
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2563
Mailing Address - Country:US
Mailing Address - Phone:910-483-5737
Mailing Address - Fax:910-483-2327
Practice Address - Street 1:4140 FERNCREEK DR
Practice Address - Street 2:SUITE 803
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2563
Practice Address - Country:US
Practice Address - Phone:910-483-5737
Practice Address - Fax:910-483-2327
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLP. 75224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist