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General NPI Number Information
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NPI Number | 1972543148
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Entity Type | Individual
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Provider Name | BARRY WORKMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 650 JOEL DR
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City | FORT CAMPBELL
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State | KY
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Zip | 42223
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Country | US
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Telephone | 270-461-5035
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Fax | 931-645-4104
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Provider Business Mailing Address
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Address Line | 12647 OLIVE BLVD SUITE 600
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6345
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301087528
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License Number State | MI
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