Provider Demographics
NPI:1073505350
Name:BARNES, JEFFREY J (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:BARNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2001 COOLIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1378
Mailing Address - Country:US
Mailing Address - Phone:517-337-0316
Mailing Address - Fax:517-337-1779
Practice Address - Street 1:1535 E BROOMFIELD ST STE A
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4489
Practice Address - Country:US
Practice Address - Phone:989-772-3339
Practice Address - Fax:989-772-4846
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301052884207W00000X
MIJB052884207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
JB052884OtherSTATE LICENSE NUMBER
MI2884200Medicaid
MI1962485342OtherGROUP NPI NUMBER
MION25050Medicare ID - Type Unspecified
MI1962485342OtherGROUP NPI NUMBER
MI2884200Medicaid