Healthcare Provider Details

I. General information

NPI: 1366881427
Provider Name (Legal Business Name): CODY JAMISON BARNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE STE 420
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8109
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-2829
  • Fax: 314-362-5743
Mailing address:
  • Phone: 314-747-2829
  • Fax: 314-362-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number2018036776
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2018036776
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: