Provider Demographics
NPI:1962643478
Name:BARLEY, THEOPHILE (MD)
Entity Type:Individual
Prefix:
First Name:THEOPHILE
Middle Name:
Last Name:BARLEY
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:PO BOX 217
Mailing Address - Street 2:220 ESSIE DAVISON DR.,
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-2915
Mailing Address - Country:US
Mailing Address - Phone:712-542-2176
Mailing Address - Fax:712-542-8311
Practice Address - Street 1:220 ESSIE DAVISON DR
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-2915
Practice Address - Country:US
Practice Address - Phone:712-542-2176
Practice Address - Fax:712-542-8397
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.3021R207Q00000X
IA38630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI10723034Medicare Oscar/Certification