Provider Demographics
NPI:1275577926
Name:BARNES, RANDALL C (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:C
Last Name:BARNES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1057 MEDICAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3000
Practice Address - Country:US
Practice Address - Phone:573-302-3200
Practice Address - Fax:573-302-3210
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3A38207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00663674OtherRAIL ROAD MEDICARE
MO241215805Medicaid
MOD41479Medicare UPIN
MO135570007Medicare PIN