Provider Demographics
NPI:1568562437
Name:BARNES, REGINALD W (MD)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:W
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 1:9601 LILE DR STE 700
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6329
Mailing Address - Country:US
Mailing Address - Phone:501-219-1970
Mailing Address - Fax:501-219-1944
Practice Address - Street 1:9601 LILE DR STE 700
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6329
Practice Address - Country:US
Practice Address - Phone:501-219-1970
Practice Address - Fax:501-219-1944
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6211174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR53633OtherMEDICARE ID
AR117491001Medicaid
ARE42351Medicare UPIN
AR53633Medicare PIN