Provider Demographics
NPI:1326063991
Name:BARRON, MICHAEL O'NEILL JR (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:O'NEILL
Last Name:BARRON
Suffix:JR
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 1:8515 DELMAR BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2168
Mailing Address - Country:US
Mailing Address - Phone:314-667-5276
Mailing Address - Fax:314-677-3838
Practice Address - Street 1:8515 DELMAR BLVD STE 217
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2168
Practice Address - Country:US
Practice Address - Phone:314-667-5276
Practice Address - Fax:314-677-3838
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020879207Q00000X
IL036-109935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370663567-62269-01Medicaid
IL036109935-5Medicaid
IL036109935-5Medicaid
ILI16730Medicare UPIN