Provider Demographics
NPI:1164484317
Name:BARNES, ROBERT OWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:OWEN
Last Name:BARNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 SEARLS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-3029
Mailing Address - Country:US
Mailing Address - Phone:530-478-1064
Mailing Address - Fax:530-478-9461
Practice Address - Street 1:590 SEARLS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3029
Practice Address - Country:US
Practice Address - Phone:530-478-1064
Practice Address - Fax:530-478-9461
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG333700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G333700Medicaid
CA00G333700Medicare ID - Type Unspecified
CA00G333700Medicaid