Healthcare Provider Details

I. General information

NPI: 1629008024
Provider Name (Legal Business Name): ROBERT DOUGLASS BARNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 MINNICH RD SUITE 4
NEW HAVEN IN
46774-2052
US

IV. Provider business mailing address

1302 MINNICH RD SUITE 4
NEW HAVEN IN
46774-2052
US

V. Phone/Fax

Practice location:
  • Phone: 260-493-6508
  • Fax: 260-493-6509
Mailing address:
  • Phone: 260-493-6508
  • Fax: 260-493-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01026191A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: