Healthcare Provider Details

I. General information

NPI: 1437109758
Provider Name (Legal Business Name): JEFFREY IAN BARKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUPERIOR AVE STE 100
NEWPORT BEACH CA
92663-3660
US

IV. Provider business mailing address

500 SUPERIOR AVE STE 100
NEWPORT BEACH CA
92663-3660
US

V. Phone/Fax

Practice location:
  • Phone: 949-706-3300
  • Fax: 949-706-3301
Mailing address:
  • Phone: 949-706-3300
  • Fax: 949-706-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG72290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: