Provider Demographics
NPI:1275529083
Name:BARTON, RICHARD SHANE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SHANE
Last Name:BARTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7925 YOUREE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5538
Mailing Address - Country:US
Mailing Address - Phone:318-212-6700
Mailing Address - Fax:318-212-6799
Practice Address - Street 1:7925 YOUREE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5538
Practice Address - Country:US
Practice Address - Phone:318-212-6700
Practice Address - Fax:318-212-6799
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15529R207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1627461Medicaid
LAI10322Medicare UPIN
LA4J754CR96Medicare PIN
LA4J754Medicare PIN
LA1627461Medicaid