Provider Demographics
NPI:1982653614
Name:BARNES, LARRY G (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:G
Last Name:BARNES
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 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-455-4200
Mailing Address - Fax:417-455-4314
Practice Address - Street 1:336 S JEFFERSON
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850
Practice Address - Country:US
Practice Address - Phone:417-455-4200
Practice Address - Fax:417-455-4314
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
100238OtherANTHEM
P00248173OtherRR MEDICARE
100238OtherANTHEM