Provider Demographics
NPI:1871641001
Name:BARNES, CHARLES JENCKES (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JENCKES
Last Name:BARNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6123 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1549
Mailing Address - Country:US
Mailing Address - Phone:510-237-2823
Mailing Address - Fax:510-237-9213
Practice Address - Street 1:6123 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1549
Practice Address - Country:US
Practice Address - Phone:510-237-2823
Practice Address - Fax:510-237-9213
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G287630Medicaid
CA00G287630Medicaid
00G287630Medicare ID - Type Unspecified