Provider Demographics
NPI:1154390797
Name:BARRON, WILLIAM EVANS (PA-C)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EVANS
Last Name:BARRON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:IA
Mailing Address - Zip Code:50025-1052
Mailing Address - Country:US
Mailing Address - Phone:712-563-2611
Mailing Address - Fax:712-563-3078
Practice Address - Street 1:515 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:IA
Practice Address - Zip Code:50025-1052
Practice Address - Country:US
Practice Address - Phone:712-563-2611
Practice Address - Fax:712-563-3078
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAR91285Medicare UPIN
I9368Medicare PIN