Provider Demographics
NPI:1659626182
Name:BARNES, MARTIN R
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:R
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 NE 11TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-2605
Mailing Address - Country:US
Mailing Address - Phone:405-230-1138
Mailing Address - Fax:405-425-8336
Practice Address - Street 1:1501 NE 11TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-2605
Practice Address - Country:US
Practice Address - Phone:405-230-1138
Practice Address - Fax:405-425-8336
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker