Provider Demographics
NPI:1376640284
Name:REGINALD WB BARNES MD PA
Entity Type:Organization
Organization Name:REGINALD WB BARNES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:WILLIE BERNARD
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-663-3510
Mailing Address - Street 1:ONE ST VINCENT CIRCLE SUITE 360
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-663-3510
Mailing Address - Fax:501-663-3741
Practice Address - Street 1:ONE ST VINCENT CIRCLE SUITE 360
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-663-3510
Practice Address - Fax:501-663-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6211208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR15375000000OtherQUALCHOICE
AR53633OtherBLUE CROSS
GA3720020OtherUNITED HEALTH
GA3720020OtherUNITED HEALTH
AR53633Medicare ID - Type Unspecified