MEDICARE: DR. BRADLEY D BARKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35058929	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619191731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY D BARKER MD

Provider Business Mailing Address
First Line	:	1120 E BROAD ST STE 200
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-6306
Country	:	US
Telephone Number	:	440-326-4410
Fax Number	:	216-201-6913

Provider Business Practice Location Address
First Line	:	1120 E BROAD ST
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-6306
Country	:	US
Telephone Number	:	440-365-8487
Fax Number	:	440-365-5486

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	12/08/2020

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