Healthcare Provider Details

I. General information

NPI: 1386645463
Provider Name (Legal Business Name): RICHARD LEE BARNES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 DOUGHERTY FERRY ROAD STE. 103
ST. LOUIS MO
63122
US

IV. Provider business mailing address

2315 DOUGHERTY FERRY ROAD SUITE. 103
ST. LOUIS MO
63122
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-5002
  • Fax: 314-821-5029
Mailing address:
  • Phone: 314-821-5002
  • Fax: 314-821-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberDO101482
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier248674707
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: