Provider Demographics
NPI:1720015613
Name:BARNES, BRYAN D (DO)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:D
Last Name:BARNES
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 2511
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2511
Mailing Address - Country:US
Mailing Address - Phone:417-781-0250
Mailing Address - Fax:417-781-2581
Practice Address - Street 1:1901 E 32ND ST STE 4
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3071
Practice Address - Country:US
Practice Address - Phone:417-781-0250
Practice Address - Fax:417-781-2581
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
119873OtherANTHEM
MO244684304Medicaid
119873OtherANTHEM
MO001013525Medicare PIN
119873OtherANTHEM
KS100342080AMedicaid
MO001013525Medicare PIN