Provider Demographics
NPI:1568674166
Name:DONALD W BARHAM, M.D.
Entity Type:Organization
Organization Name:DONALD W BARHAM, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-793-1070
Mailing Address - Street 1:1750 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301
Mailing Address - Country:US
Mailing Address - Phone:334-793-1070
Mailing Address - Fax:334-793-5114
Practice Address - Street 1:1750 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1318
Practice Address - Country:US
Practice Address - Phone:334-793-1070
Practice Address - Fax:334-793-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7566207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00012585Medicaid
AL51012585OtherBCBS
GA00261137AMedicaid
AL00012585Medicare ID - Type Unspecified
GA00261137AMedicaid