Barry Douglas Bronner, OTR

Primary specialty

SpecialistTaxonomy code 174400000X

License

106497 Issued in TX

Practice address

4800 Memorial Dr
Waco, TX 76711-1329

Phone

(254) 297-3770

Fax

(254) 297-3875

NPI assigned

Feb 14, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568505485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 N 26TH ST",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767081946",
            "telephone_number": "254-644-9244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 MEMORIAL DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767111329",
            "telephone_number": "254-297-3770",
            "fax_number": "254-297-3875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONNER",
        "first_name": "BARRY",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "106497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Waco, TX
• Providers in Waco, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.