Provider Demographics
NPI:1629131784
Name:BARTON, AMY L (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:BARTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-706-8526
Mailing Address - Fax:214-648-3220
Practice Address - Street 1:UT SOUTHWESTERN MEDICAL CTR
Practice Address - Street 2:5323 HARRY HINES BLVD
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9063
Practice Address - Country:US
Practice Address - Phone:214-648-3405
Practice Address - Fax:214-648-3220
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD38570208000000X
MN49922208000000X
TXN34832080C0008X
IDM-11758208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN467603000Medicaid
TNBB7924396OtherDEA
H92185Medicare UPIN
MN370003322Medicare PIN