Provider Demographics
NPI:1417941881
Name:BARNES, LARRY ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ALLEN
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 1:1520 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2917
Mailing Address - Country:US
Mailing Address - Phone:309-762-8555
Mailing Address - Fax:309-736-0733
Practice Address - Street 1:1520 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2917
Practice Address - Country:US
Practice Address - Phone:309-762-8555
Practice Address - Fax:309-736-0733
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1039982Medicaid
D46511Medicare UPIN
ILK05382Medicare ID - Type Unspecified