Provider Demographics
NPI:1629092036
Name:BARBER, MARK A (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BARBER
Suffix:
Gender:M
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:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:ANAHUAC
Mailing Address - State:TX
Mailing Address - Zip Code:77514-0398
Mailing Address - Country:US
Mailing Address - Phone:409-267-3143
Mailing Address - Fax:
Practice Address - Street 1:1975 STIRLING DR
Practice Address - Street 2:
Practice Address - City:INTERLOCHEN
Practice Address - State:MI
Practice Address - Zip Code:49643-9264
Practice Address - Country:US
Practice Address - Phone:231-275-7965
Practice Address - Fax:231-275-7969
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG97187Medicare UPIN
MIN38430006Medicare PIN