Healthcare Provider Details

I. General information

NPI: 1669376109
Provider Name (Legal Business Name): WILLIAM BARNES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W STEVE OWENS BLVD
MIAMI OK
74354-7629
US

IV. Provider business mailing address

304 N MICKEY MANTLE BLVD
COMMERCE OK
74339-1110
US

V. Phone/Fax

Practice location:
  • Phone: 918-675-4100
  • Fax:
Mailing address:
  • Phone: 918-675-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: