Provider Demographics
NPI:1699090167
Name:BARSON, BRENT MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:MICHAEL
Last Name:BARSON
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 1:465 N CLEVELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8642
Mailing Address - Country:US
Mailing Address - Phone:614-899-0000
Mailing Address - Fax:614-899-0524
Practice Address - Street 1:465 N CLEVELAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8642
Practice Address - Country:US
Practice Address - Phone:614-899-0000
Practice Address - Fax:614-899-0524
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-28
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34010659208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0135275Medicaid