Healthcare Provider Details

I. General information

NPI: 1023178530
Provider Name (Legal Business Name): RODNEY JAY BARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 WEST RD SUITE #125
LOS ALAMOS NM
87544-2275
US

IV. Provider business mailing address

3917 WEST ROAD SUITE #125
LOS ALAMOS NM
87544
US

V. Phone/Fax

Practice location:
  • Phone: 505-661-3030
  • Fax: 505-662-9024
Mailing address:
  • Phone: 505-661-3030
  • Fax: 505-662-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2004-0528
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: