Provider Demographics
NPI:1487687208
Name:BARNARD, LIFE (MD)
Entity Type:Individual
Prefix:
First Name:LIFE
Middle Name:
Last Name:BARNARD
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:PO BOX 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-333-3996
Mailing Address - Fax:432-333-5801
Practice Address - Street 1:421 GOLDER AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5011
Practice Address - Country:US
Practice Address - Phone:432-333-3996
Practice Address - Fax:432-333-5801
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0340705-01Medicaid
TXB21097Medicare UPIN
TX00J742Medicare PIN