Provider Demographics
NPI:1932976800
Name:BARNES, ELMO E SR
Entity Type:Individual
Prefix:MR
First Name:ELMO
Middle Name:E
Last Name:BARNES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E BROADWAY RD STE 21
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1735
Mailing Address - Country:US
Mailing Address - Phone:602-884-3360
Mailing Address - Fax:602-671-9203
Practice Address - Street 1:2101 E BROADWAY RD STE 21
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1735
Practice Address - Country:US
Practice Address - Phone:602-884-3360
Practice Address - Fax:602-671-9203
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management