Provider Demographics
NPI:1083602171
Name:BARKER, MICHAEL DANIEL (PAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DANIEL
Last Name:BARKER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 E BARNETT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8343
Mailing Address - Country:US
Mailing Address - Phone:541-779-6250
Mailing Address - Fax:541-608-2535
Practice Address - Street 1:2780 E BARNETT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8343
Practice Address - Country:US
Practice Address - Phone:541-779-6250
Practice Address - Fax:541-608-2535
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00782363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134081Medicaid
OR134081Medicaid
111454Medicare ID - Type Unspecified