Healthcare Provider Details

I. General information

NPI: 1821132978
Provider Name (Legal Business Name): JACQUELINE ANNE BARBOUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 HIGH ST
EUGENE OR
97401-4151
US

IV. Provider business mailing address

1670 HIGH ST
EUGENE OR
97401-4151
US

V. Phone/Fax

Practice location:
  • Phone: 541-344-9411
  • Fax: 541-344-6519
Mailing address:
  • Phone: 541-344-9411
  • Fax: 541-344-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number12242
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: