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General NPI Number Information
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NPI Number | 1134774524
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Entity Type | Individual
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Provider Name | ANTONIO RICHARD BARRON PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/03/2019
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 5717 OAKLAND DR STE A
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City | PORTAGE
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State | MI
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Zip | 49024
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Country | US
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Telephone | 269-218-2443
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Fax |
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Provider Business Mailing Address
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Address Line | 7668 ASPEN LN
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City | KALAMAZOO
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State | MI
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Zip | 49009-3944
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Country | US
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Telephone | 989-284-9478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601009203
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License Number State | MI
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