Provider Demographics
NPI:1972544013
Name:BARKER, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:BARKER
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 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 OHIO HEALTH BLVD STE 160
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-7883
Practice Address - Country:US
Practice Address - Phone:740-615-0112
Practice Address - Fax:740-615-0253
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084556B207R00000X
OH35.084556207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
311098079OtherTAX ID
0112877OtherUHC
311098079OtherPPO NEXT
311098079OtherTAXID PHYSICIANS AND NONP
353077OtherSUBMITTER NO
7257142OtherAETNA
OH2370901Medicaid
311098079OtherCIGNA
311098079OtherPPO NEXT
H14442Medicare UPIN
P00163980Medicare ID - Type UnspecifiedTRAVELERS
0112877OtherUHC
OH2370901Medicaid