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NPI 1174616122

NPI 1174616122 : RICHARD E. BARNES M.D. : LANDER, WY

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General NPI Number Information
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    NPI Number           |    1174616122
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    Entity Type          |    Individual 
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    Provider Name        |    RICHARD E. BARNES M.D.
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    10/02/2006
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    Last Update Date     |    01/17/2012
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Provider Practice Location Address
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    Address Line         |    115 WYOMING ST 
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    City                 |    LANDER
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    State                |    WY
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    Zip                  |    82520-3919
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    Country              |    US
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    Telephone            |    307-332-2185
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    Fax                  |    307-332-7799
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Provider Business Mailing Address
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    Address Line         |    115 WYOMING ST 
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    City                 |    LANDER
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    State                |    WY
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    Zip                  |    82520-3919
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    Country              |    US
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    Telephone            |    307-332-2185
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    Fax                  |    307-332-7799
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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        |    208000000X
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    Taxonomy Name        |    Pediatrics Physician
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    License Number       |    5774A
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    License Number State |    WY
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