Healthcare Provider Details

I. General information

NPI: 1093717126
Provider Name (Legal Business Name): LORRAINE T BARNES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SANTA ROSA ST
SAN ANTONIO TX
78207-3108
US

IV. Provider business mailing address

315 N SAN SABA STE. 1003
SAN ANTONIO TX
78207-3154
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-4966
  • Fax: 210-704-2532
Mailing address:
  • Phone: 210-704-4966
  • Fax: 210-704-2532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG4810
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: