Healthcare Provider Details

I. General information

NPI: 1629092036
Provider Name (Legal Business Name): MARK A. BARBER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 STIRLING DR
INTERLOCHEN MI
49643-9264
US

IV. Provider business mailing address

PO BOX 398
ANAHUAC TX
77514-0398
US

V. Phone/Fax

Practice location:
  • Phone: 231-275-7965
  • Fax: 231-275-7969
Mailing address:
  • Phone: 409-267-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101013221
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: