Healthcare Provider Details

I. General information

NPI: 1659375038
Provider Name (Legal Business Name): RICHARD J BARTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W 22ND ST
SIOUX FALLS SD
57105-1501
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-8700
  • Fax: 605-328-8701
Mailing address:
  • Phone: 605-328-6585
  • Fax: 605-328-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2774
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: