Provider Demographics
NPI:1972595916
Name:BARNES, PATRICK M (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
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 1:320 MCKENZIE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1002
Mailing Address - Country:US
Mailing Address - Phone:712-328-0297
Mailing Address - Fax:712-328-2403
Practice Address - Street 1:320 MCKENZIE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1002
Practice Address - Country:US
Practice Address - Phone:712-328-0297
Practice Address - Fax:712-328-2403
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA630213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0140707Medicaid
IAU57158Medicare UPIN
IA54816Medicare PIN