Provider Demographics
NPI:1104890599
Name:BARBA, ANTONIO P JR (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:P
Last Name:BARBA
Suffix:JR
Gender:M
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:PO BOX 781866
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67278-1866
Mailing Address - Country:US
Mailing Address - Phone:316-691-2301
Mailing Address - Fax:
Practice Address - Street 1:1515 S CLIFTON AVE
Practice Address - Street 2:STE. 450
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2900
Practice Address - Country:US
Practice Address - Phone:316-691-2301
Practice Address - Fax:316-691-2306
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0416566174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0416566OtherKS ST. LICENSE
KS0416566OtherKS ST. LICENSE
KS002470Medicare ID - Type Unspecified