Provider Demographics
NPI:1992960579
Name:BARTH, DAVID JOHN (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:BARTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10170 W TROPICANA AVE # 156-290
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8465
Mailing Address - Country:US
Mailing Address - Phone:855-722-7747
Mailing Address - Fax:855-458-2910
Practice Address - Street 1:2779 W HORIZON RIDGE PKWY STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4186
Practice Address - Country:US
Practice Address - Phone:702-589-9250
Practice Address - Fax:702-589-9257
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1992960579Medicaid