Provider Demographics
NPI:1902891989
Name:BARRON, JOSE O JR (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:O
Last Name:BARRON
Suffix:JR
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 FUTURA DR.
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201
Mailing Address - Country:US
Mailing Address - Phone:575-624-8458
Mailing Address - Fax:575-624-8446
Practice Address - Street 1:101 W COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5174
Practice Address - Country:US
Practice Address - Phone:575-624-8458
Practice Address - Fax:575-624-8287
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer