Provider Demographics
NPI:1043572407
Name:BARNES, MARK (CNIM, R EP T)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:BARNES
Suffix:
Gender:M
Credentials:CNIM, R EP T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 E GILLETTE ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-8754
Mailing Address - Country:US
Mailing Address - Phone:918-809-4479
Mailing Address - Fax:
Practice Address - Street 1:3319 E GILLETTE ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-8754
Practice Address - Country:US
Practice Address - Phone:918-809-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic