Provider Demographics
NPI:1588612576
Name:BARKER, CHARLES R JR (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:BARKER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W STATE STREET
Mailing Address - Street 2:STE 3A
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-9245
Mailing Address - Country:US
Mailing Address - Phone:616-794-1810
Mailing Address - Fax:616-794-1947
Practice Address - Street 1:1320 W STATE ST
Practice Address - Street 2:STE 3A
Practice Address - City:BELDING
Practice Address - State:MI
Practice Address - Zip Code:48809-9245
Practice Address - Country:US
Practice Address - Phone:616-794-1810
Practice Address - Fax:616-794-1947
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4784508Medicaid
MI1598712390OtherGROUP NPI
MI4784482Medicaid
MI4784491Medicaid
MI0853400104OtherBCBS
MI4784473Medicaid
MI4784464Medicaid