Provider Demographics
NPI:1558396010
Name:BARNES, PHILLIP LANCE (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:LANCE
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:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39533-0425
Mailing Address - Country:US
Mailing Address - Phone:228-374-7888
Mailing Address - Fax:228-435-1545
Practice Address - Street 1:201 LAMEUSE ST
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-3107
Practice Address - Country:US
Practice Address - Phone:228-374-7888
Practice Address - Fax:228-435-1545
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019091Medicaid
MS00019091Medicaid
MSD89603Medicare UPIN