Healthcare Provider Details

I. General information

NPI: 1891991279
Provider Name (Legal Business Name): JESSE BARNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CALLE DEL PRESIDENTE
BERNALILLO NM
87004-6091
US

IV. Provider business mailing address

801 FITZGERALD RD NW
ALBUQUERQUE NM
87107-2437
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-2324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2008-0764
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: