Provider Demographics
NPI:1932174539
Name:BARNES, LAWRENCE RAY (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:RAY
Last Name:BARNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1375 N 10TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-2099
Mailing Address - Country:US
Mailing Address - Phone:503-769-7546
Mailing Address - Fax:503-769-8563
Practice Address - Street 1:1375 N 10TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-2099
Practice Address - Country:US
Practice Address - Phone:503-769-7546
Practice Address - Fax:503-769-8563
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD9267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR017079Medicaid
ORMD9267OtherSTATE LICENSE
ORMD9267OtherSTATE LICENSE
ORMD9267OtherSTATE LICENSE