Provider Demographics
NPI:1184685174
Name:BARNES, LAWRENCE J (PA-C)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:BARNES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5249 SALUKI DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3923
Mailing Address - Country:US
Mailing Address - Phone:618-334-7684
Mailing Address - Fax:
Practice Address - Street 1:3 SAINT ELIZABETH BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1281
Practice Address - Country:US
Practice Address - Phone:618-641-5803
Practice Address - Fax:618-607-5116
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILOTH000Medicare UPIN
ILIL4903005Medicare PIN