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General NPI Number Information
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NPI Number | 1760913024
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Entity Type | Organization
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Legal Business Name | BRYAN O. BARNETT, M.D.
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 1542A N TRACY BLVD
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City | TRACY
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State | CA
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Zip | 95376-2958
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Country | US
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Telephone | 209-836-2220
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Fax | 209-836-0726
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Provider Business Mailing Address
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Address Line | 1542A N TRACY BLVD
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City | TRACY
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State | CA
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Zip | 95376-2958
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Country | US
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Telephone | 209-836-2220
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Fax | 209-836-0726
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Authorized Official
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Title or Position | OWNER
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Name | BRYAN O BARNETT
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Credential | M.D.
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Telephone | 209-836-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G49758
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License Number State | CA
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