Healthcare Provider Details

I. General information

NPI: 1982679072
Provider Name (Legal Business Name): JANE MARIE BARKER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 61 AND 32
STE. GENEVIEVE MO
63670
US

IV. Provider business mailing address

1144 LAZY HOLLOW CT
O FALLON IL
62269-7043
US

V. Phone/Fax

Practice location:
  • Phone: 573-883-7786
  • Fax:
Mailing address:
  • Phone: 618-628-2193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number112187
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-110429
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number112187
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: