Provider Demographics
NPI:1568448041
Name:BARNES, VICTOR RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:RUSSELL
Last Name:BARNES
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 1:472D WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6824
Mailing Address - Country:US
Mailing Address - Phone:910-238-4513
Mailing Address - Fax:910-238-4745
Practice Address - Street 1:472D WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6824
Practice Address - Country:US
Practice Address - Phone:910-238-4513
Practice Address - Fax:910-238-4745
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93000222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913388Medicaid
NC13388OtherBC/BS
NCF61333Medicare PIN
NC8913388Medicaid
NC2188890BMedicare ID - Type Unspecified