Provider Demographics
NPI:1699272633
Name:BARNEY, WALTER (SURGICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:BARNEY
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 LUNA VIS
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-2003
Mailing Address - Country:US
Mailing Address - Phone:505-850-7953
Mailing Address - Fax:505-983-8724
Practice Address - Street 1:708 LUNA VIS
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-2003
Practice Address - Country:US
Practice Address - Phone:505-850-7953
Practice Address - Fax:505-983-8724
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical