Healthcare Provider Details

I. General information

NPI: 1699090167
Provider Name (Legal Business Name): BRENT MICHAEL BARSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2010
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N CLEVELAND AVE STE 200
WESTERVILLE OH
43082-8642
US

IV. Provider business mailing address

465 N CLEVELAND AVE STE 200
WESTERVILLE OH
43082-8642
US

V. Phone/Fax

Practice location:
  • Phone: 614-899-0000
  • Fax: 614-899-0524
Mailing address:
  • Phone: 614-899-0000
  • Fax: 614-899-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34010659
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: