Provider Demographics
NPI:1770640393
Name:BARNES, JEFFREY GEORGE (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GEORGE
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 1:120 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-6684
Mailing Address - Country:US
Mailing Address - Phone:910-603-6064
Mailing Address - Fax:
Practice Address - Street 1:120 SHANNON DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-6684
Practice Address - Country:US
Practice Address - Phone:910-603-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL168732085R0202X
NC2006-010012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology