Healthcare Provider Details

I. General information

NPI: 1336156116
Provider Name (Legal Business Name): DONALD W BARNES PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 N FLAMINGO DR
SEABROOK TX
77586-1810
US

IV. Provider business mailing address

646 N FLAMINGO DR
SEABROOK TX
77586-1810
US

V. Phone/Fax

Practice location:
  • Phone: 281-474-9406
  • Fax:
Mailing address:
  • Phone: 281-474-9406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1002087
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: