Healthcare Provider Details

I. General information

NPI: 1215851522
Provider Name (Legal Business Name): EDWARD BARBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS DR
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

6903 MINNESOTA AVE
SAINT LOUIS MO
63111-2850
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-6583
  • Fax:
Mailing address:
  • Phone: 845-863-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: