Provider Demographics
NPI:1124081211
Name:BARNES, DAVID L (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:BARNES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK610517800OtherDEPARTMENT OF LABOR
AK050582551OtherTAX ID
AKDD1707OtherMEDICARE RAILROAD
AKMD2640Medicaid
AKH57925Medicare UPIN
AK050582551OtherTAX ID