Provider Demographics
NPI:1992490551
Name:BARRY, TREVOR
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:BARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 VINCENT ST., SPACE BASE DELTA 1
Mailing Address - Street 2:
Mailing Address - City:PETERSON SPACE FORCE BASE
Mailing Address - State:CO
Mailing Address - Zip Code:80914-5411
Mailing Address - Country:US
Mailing Address - Phone:702-576-6625
Mailing Address - Fax:
Practice Address - Street 1:5486 BUCKEYE ST RM 123
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45433-5411
Practice Address - Country:US
Practice Address - Phone:702-576-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians