Provider Demographics
NPI:1962408468
Name:WIDMER, BARBARA LILLIAN (DPM)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LILLIAN
Last Name:WIDMER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 GLEN ELLEN DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1732
Mailing Address - Country:US
Mailing Address - Phone:805-642-1506
Mailing Address - Fax:
Practice Address - Street 1:352 GLEN ELLEN DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1732
Practice Address - Country:US
Practice Address - Phone:805-642-1506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2747213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E27470Medicaid
CA000E27470Medicaid
CAE2747Medicare ID - Type Unspecified