1629370010 NPI number — MR. DAVID JOSEPH BARRY III M.A.

Table of content: MR. DAVID JOSEPH BARRY III M.A. (NPI 1629370010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629370010 NPI number — MR. DAVID JOSEPH BARRY III M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRY
Provider First Name:
DAVID
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629370010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
729 GRAPEVINE HWY # 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURST
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76054-2805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-762-5741
Provider Business Mailing Address Fax Number:
650-880-2899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1510 FASHION ISLAND BLVD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-762-5741
Provider Business Practice Location Address Fax Number:
650-880-2899
Provider Enumeration Date:
11/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  202763 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 65280 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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