Provider Demographics
NPI:1194717819
Name:BARNETT, ANDY STUART (MD)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:STUART
Last Name:BARNETT
Suffix:
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 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-0924
Mailing Address - Fax:503-494-5339
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-0924
Practice Address - Fax:503-494-5339
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045686207P00000X
CAA88253207Q00000X
ORMD150769207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0227522OtherLIWA
WA1450BAOtherBSWA
WA2497BAOtherBSWA
605960013OtherUSDLAB
WA8466021Medicaid
WAI66064Medicare UPIN
WA0227522OtherLIWA
WA8466021Medicaid