Provider Demographics
NPI:1780842419
Name:BARNHART, MICHAEL ROGER (IDC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROGER
Last Name:BARNHART
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NOLF BLDG 169
Mailing Address - Street 2:BOX 347140
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92135-7140
Mailing Address - Country:US
Mailing Address - Phone:619-241-9880
Mailing Address - Fax:
Practice Address - Street 1:NOLF BLDG 169
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92135-7140
Practice Address - Country:US
Practice Address - Phone:619-241-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman