Provider Demographics
NPI:1477849602
Name:BARNES, BLAKE WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:WILLIAM
Last Name:BARNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:DCO58.00
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5276
Mailing Address - Country:US
Mailing Address - Phone:573-882-4438
Mailing Address - Fax:573-884-9992
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:DCO58.00
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5276
Practice Address - Country:US
Practice Address - Phone:573-882-4438
Practice Address - Fax:573-884-9992
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011019428208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics