Provider Demographics
NPI:1962962217
Name:BARBER, HEATHER (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BARBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374TH MEDICAL GROUP, UNIT 5071
Mailing Address - Street 2:
Mailing Address - City:APO AP
Mailing Address - State:FUSSA
Mailing Address - Zip Code:96328
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:374TH MEDICAL GROUP, UNIT 5071, APO AP
Practice Address - Street 2:
Practice Address - City:TOKYO
Practice Address - State:FUSSA
Practice Address - Zip Code:96328
Practice Address - Country:JP
Practice Address - Phone:315-225-7508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01086035A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery