Provider Demographics
NPI:1427033620
Name:BARBETTINI, ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BARBETTINI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W BOISE CIR STE 160
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4932
Mailing Address - Country:US
Mailing Address - Phone:918-994-9130
Mailing Address - Fax:918-403-6306
Practice Address - Street 1:800 W BOISE CIR STE 160
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012
Practice Address - Country:US
Practice Address - Phone:918-994-9130
Practice Address - Fax:918-403-6306
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1347363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ12981Medicare UPIN