Provider Demographics
NPI:1619919198
Name:WOTHERSPOON, BARBARA E (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:E
Last Name:WOTHERSPOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E PRIMROSE ST
Mailing Address - Street 2:STE E
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5233
Mailing Address - Country:US
Mailing Address - Phone:814-274-9300
Mailing Address - Fax:
Practice Address - Street 1:7150 W SUNSET RD STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1981
Practice Address - Country:US
Practice Address - Phone:702-514-1411
Practice Address - Fax:702-514-1413
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427407207V00000X
MO2007015351207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH64581Medicare UPIN
PA095460Medicare ID - Type Unspecified