Healthcare Provider Details

I. General information

NPI: 1801892526
Provider Name (Legal Business Name): ALAN JOSEPH BARTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 JOY LANE STE B
FORT MOHAVE AZ
86426
US

IV. Provider business mailing address

1611 JOY LANE STE B
FORT MOHAVE AZ
86426
US

V. Phone/Fax

Practice location:
  • Phone: 928-788-8000
  • Fax: 928-788-8008
Mailing address:
  • Phone: 928-788-8000
  • Fax: 928-788-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29312
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: