Provider Demographics
NPI:1942392113
Name:BARNES, JOHN M (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:BARNES
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 1:506 NE 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2928
Mailing Address - Country:US
Mailing Address - Phone:503-297-2222
Mailing Address - Fax:
Practice Address - Street 1:506 NE 49TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2928
Practice Address - Country:US
Practice Address - Phone:503-297-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00328213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR228748Medicaid
OR228748Medicaid
U89515Medicare UPIN