Provider Demographics
NPI:1942206891
Name:BARKER, BRENT (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:BARKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18007 NE 26TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-0735
Mailing Address - Country:US
Mailing Address - Phone:360-896-3836
Mailing Address - Fax:360-896-8891
Practice Address - Street 1:18007 NE 26TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-0735
Practice Address - Country:US
Practice Address - Phone:360-896-3836
Practice Address - Fax:360-896-8891
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000574213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1101856Medicaid
WA1109677Medicaid
WAU66925Medicare UPIN
WAAB05449Medicare ID - Type Unspecified
WA1101856Medicaid