Provider Demographics
NPI:1679526875
Name:BARNES, MADGE L (MD)
Entity Type:Individual
Prefix:
First Name:MADGE
Middle Name:L
Last Name:BARNES
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 1:2950 W CAMP WISDOM RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4461
Mailing Address - Country:US
Mailing Address - Phone:972-352-2937
Mailing Address - Fax:972-352-2996
Practice Address - Street 1:2950 W CAMP WISDOM RD STE 100
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-4461
Practice Address - Country:US
Practice Address - Phone:972-352-2937
Practice Address - Fax:972-352-2996
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1379331-02Medicaid
TXP01398099OtherRAILROAD MEDICARE
TX060810106Medicaid
TX8CT555OtherBCBS
TXTXB129090Medicare PIN
TXPH0038Medicare PIN
TX8CT555OtherBCBS