Provider Demographics
NPI:1316065394
Name:IVKER, BARRY (PHD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:IVKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 FOOTHILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-2310
Mailing Address - Country:US
Mailing Address - Phone:205-979-9440
Mailing Address - Fax:205-979-9440
Practice Address - Street 1:2559 FOOTHILLS DRIVE
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-2310
Practice Address - Country:US
Practice Address - Phone:205-979-9440
Practice Address - Fax:205-979-9440
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL08021941C104100000X
LA1715104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
5X120Medicare ID - Type Unspecified