Provider Demographics
NPI:1801876115
Name:CROMER, BARRY L (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:L
Last Name:CROMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W COUNTRY CLUB RD STE 130
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5249
Mailing Address - Country:US
Mailing Address - Phone:575-625-2669
Mailing Address - Fax:575-624-4632
Practice Address - Street 1:300 W COUNTRY CLUB RD STE 130
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5249
Practice Address - Country:US
Practice Address - Phone:575-625-2669
Practice Address - Fax:575-624-4632
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9248207X00000X
NM94-221207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00021946Medicaid
TX042890601Medicaid
TX042890601Medicaid