Provider Demographics
NPI:1386645463
Name:BARNES, RICHARD LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:BARNES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2315 DOUGHERTY FERRY ROAD
Mailing Address - Street 2:SUITE. 103
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122
Mailing Address - Country:US
Mailing Address - Phone:314-821-5002
Mailing Address - Fax:314-821-5029
Practice Address - Street 1:2315 DOUGHERTY FERRY ROAD
Practice Address - Street 2:STE. 103
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122
Practice Address - Country:US
Practice Address - Phone:314-821-5002
Practice Address - Fax:314-821-5029
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO101482207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO248674707Medicaid
MOF78201Medicare UPIN
MO248674707Medicaid