Healthcare Provider Details

I. General information

NPI: 1457451486
Provider Name (Legal Business Name): MICHAEL J BARBO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/12/2025
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S WOODRUFF AVE
IDAHO FALLS ID
83401-5285
US

IV. Provider business mailing address

740 S WOODRUFF AVE
IDAHO FALLS ID
83401-5285
US

V. Phone/Fax

Practice location:
  • Phone: 208-542-9111
  • Fax: 208-542-9114
Mailing address:
  • Phone: 208-542-9111
  • Fax: 208-542-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-660
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: