Provider Demographics
NPI:1255566915
Name:BARTON, KEITH JOHN (IDMT)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:JOHN
Last Name:BARTON
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 WALDRON ST STE D
Mailing Address - Street 2:349TH AEROSPACE MEDICINE SQADRON
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-2125
Mailing Address - Country:US
Mailing Address - Phone:707-424-3812
Mailing Address - Fax:707-424-3813
Practice Address - Street 1:531 WALDRON ST STE D
Practice Address - Street 2:349TH AEROSPACE MEDICINE SQADRON
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-2125
Practice Address - Country:US
Practice Address - Phone:707-424-3812
Practice Address - Fax:707-424-3813
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians