Provider Demographics
NPI:1902890577
Name:BARR, ROBERT J (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BARR
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 1:840 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-2948
Mailing Address - Country:US
Mailing Address - Phone:440-428-7146
Mailing Address - Fax:440-428-3528
Practice Address - Street 1:840 N LAKE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2948
Practice Address - Country:US
Practice Address - Phone:440-428-7146
Practice Address - Fax:440-428-3528
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001947213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0448813Medicaid
OHBR0486212Medicare ID - Type Unspecified
OH0448813Medicaid