Provider Demographics
NPI:1679674246
Name:BARNES, MARY LOIS (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOIS
Last Name:BARNES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3919
Mailing Address - Country:US
Mailing Address - Phone:307-332-2185
Mailing Address - Fax:307-322-7799
Practice Address - Street 1:115 WYOMING ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3919
Practice Address - Country:US
Practice Address - Phone:307-332-2185
Practice Address - Fax:307-322-7799
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5773A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT504824210005Medicaid
WY111667300Medicaid
WY295833OtherALTIUS
WY303923OtherBLUE CROSS
WY303923OtherBLUE CROSS
WY295833OtherALTIUS