Provider Demographics
NPI:1376585422
Name:BARKER, JERRY LEE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:LEE
Last Name:BARKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5001 S COOPER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5993
Mailing Address - Country:US
Mailing Address - Phone:866-367-8768
Mailing Address - Fax:817-541-9501
Practice Address - Street 1:6801 OAKMONT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3918
Practice Address - Country:US
Practice Address - Phone:866-367-8768
Practice Address - Fax:817-541-9501
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK54502085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156322304Medicaid
TX156322305Medicaid
TX8S3353OtherBLUE CROSS OF TEXAS
TX8G5175Medicare PIN
TXP00312261Medicare PIN