Healthcare Provider Details

I. General information

NPI: 1083656748
Provider Name (Legal Business Name): BARBARA G. CHILTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 BUENA VISTA AVE
CARTHAGE MO
64836-3178
US

IV. Provider business mailing address

PO BOX 504944
SAINT LOUIS MO
63150-4944
US

V. Phone/Fax

Practice location:
  • Phone: 417-237-0983
  • Fax: 417-237-0997
Mailing address:
  • Phone: 417-829-4620
  • Fax: 417-829-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number100685
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: