Healthcare Provider Details

I. General information

NPI: 1932174539
Provider Name (Legal Business Name): LAWRENCE RAY BARNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LAWRENCE BARNES MD

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 N 10TH AVE SUITE B
STAYTON OR
97383-2099
US

IV. Provider business mailing address

1375 N 10TH AVE SUITE B
STAYTON OR
97383-2099
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-7546
  • Fax: 503-769-8563
Mailing address:
  • Phone: 503-769-7546
  • Fax: 503-769-8563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD9267
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: