Provider Demographics
NPI:1982657078
Name:BARNWELL, JANE O (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:O
Last Name:BARNWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 23364
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86002-3364
Mailing Address - Country:US
Mailing Address - Phone:928-714-7090
Mailing Address - Fax:928-220-8879
Practice Address - Street 1:3100 N WEST ST STE 200B
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1651
Practice Address - Country:US
Practice Address - Phone:928-714-7090
Practice Address - Fax:928-220-8879
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ207212081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ26987001Medicaid
AZC99096Medicare UPIN
AZ71614Medicare ID - Type Unspecified