Healthcare Provider Details

I. General information

NPI: 1942206891
Provider Name (Legal Business Name): BRENT BARKER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18007 NE 26TH ST
VANCOUVER WA
98684-0735
US

IV. Provider business mailing address

18007 NE 26TH ST
VANCOUVER WA
98684-0735
US

V. Phone/Fax

Practice location:
  • Phone: 360-896-3836
  • Fax: 360-896-8891
Mailing address:
  • Phone: 360-896-3836
  • Fax: 360-896-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO00000574
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: