Healthcare Provider Details

I. General information

NPI: 1922365022
Provider Name (Legal Business Name): JASON EDWARD BARKSDALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 10/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 BATH ST STE 113
SANTA BARBARA CA
93105-4339
US

IV. Provider business mailing address

DEPT LA 21613
PASADENA CA
91185-1613
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-7984
  • Fax:
Mailing address:
  • Phone: 949-263-8620
  • Fax: 800-409-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA106983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: