| Doctor Name: | MR. BARRY DOUGLAS BRONNER |
| NPI Number: | 1568505485 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | OTR |
| License Number: | 106497 |
| Business Practice Address: | 4800 Memorial Dr Waco, TX - 767111329 |
| Business Phone Number: | 2542973770 |
| Business Fax Number: | 2542973875 |
| Mailing Address: | 3301 N 26th St, WACO |
| State: | TX |
| Postal Code: | 767081946 |
| Phone Number: | 2546449244 |
| Fax Number: | |
| NPI Enumeration Date: | 02/14/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 106497 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |