Doctor Name: | DR. BARRY L FUNKHOUSER |
NPI Number: | 1164519849 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 928 |
Business Practice Address: | 301 Andrews Avenue Fort Rucker, AL - 36362 |
Business Phone Number: | 3342557387 |
Business Fax Number: | 3342557716 |
Mailing Address: | 117 Vixen Ct, DOTHAN |
State: | AL |
Postal Code: | 363059353 |
Phone Number: | 3346998516 |
Fax Number: | |
NPI Enumeration Date: | 10/06/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 928 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |