Healthcare Provider Details

I. General information

NPI: 1699872119
Provider Name (Legal Business Name): MAISHA BARNES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N BECKLEY AVE PAVILION III, SUITE 268
DALLAS TX
75203-1259
US

IV. Provider business mailing address

1411 N BECKLEY AVE PAVILION III, SUITE 268
DALLAS TX
75203-1259
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-4400
  • Fax: 214-947-4404
Mailing address:
  • Phone: 214-947-4400
  • Fax: 214-947-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberP6948
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberP6948
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: