Healthcare Provider Details

I. General information

NPI: 1982653614
Provider Name (Legal Business Name): LARRY G BARNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 S JEFFERSON
NEOSHO MO
64850
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803
US

V. Phone/Fax

Practice location:
  • Phone: 417-455-4200
  • Fax: 417-455-4314
Mailing address:
  • Phone: 417-455-4200
  • Fax: 417-455-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR7773
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: