Provider Demographics
NPI:1114958881
Name:DAVID L. BARNES, D.O. PC
Entity type:Organization
Organization Name:DAVID L. BARNES, D.O. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:907-376-2868
Mailing Address - Street 1:3719 E MERIDIAN LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7273
Mailing Address - Country:US
Mailing Address - Phone:907-376-2868
Mailing Address - Fax:907-376-2811
Practice Address - Street 1:3719 E MERIDIAN LOOP STE A
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7273
Practice Address - Country:US
Practice Address - Phone:907-376-2868
Practice Address - Fax:907-376-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2641Medicaid
AKDD1707OtherMEDICARE RAILROAD
AK152811Medicare ID - Type Unspecified
AK152810Medicare ID - Type UnspecifiedMEDICARE GP ID
AKH57925Medicare UPIN