Provider Demographics
NPI:1568472355
Name:BARBOSA, KAREN S (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:BARBOSA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 DEBARR RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2961
Mailing Address - Country:US
Mailing Address - Phone:907-222-2950
Mailing Address - Fax:907-222-5950
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:SUITE 402
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2961
Practice Address - Country:US
Practice Address - Phone:907-222-2950
Practice Address - Fax:907-222-5950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008785208600000X
AK8311208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2675172Medicaid
OHI60940Medicare UPIN
OH2675172Medicaid