Healthcare Provider Details

I. General information

NPI: 1134506793
Provider Name (Legal Business Name): GLENN BARNES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3227 E WARM SPRINGS RD BLDG 23 SUITE 300
LAS VEGAS NV
89120
US

IV. Provider business mailing address

96 MISTY RAIN ST
HENDERSON NV
89012-5656
US

V. Phone/Fax

Practice location:
  • Phone: 702-209-3590
  • Fax: 702-359-5344
Mailing address:
  • Phone: 702-234-5981
  • Fax: 702-359-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDO2246
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: