Healthcare Provider Details

I. General information

NPI: 1831579051
Provider Name (Legal Business Name): ROBERT JOHN BARNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 LAUREL ST
ANCHORAGE AK
99508-5334
US

IV. Provider business mailing address

6543 CIMARRON CIR
ANCHORAGE AK
99504-3944
US

V. Phone/Fax

Practice location:
  • Phone: 907-654-0355
  • Fax:
Mailing address:
  • Phone: 775-436-8128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: