MEDICARE: JONATHAN MACK BARHAM M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	07884R	LA
2	207V00000X	Obstetrics & Gynecology Physician	F0865	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992702641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN MACK BARHAM M. D.

Provider Business Mailing Address
First Line	:	3418 MEDICAL PARK DR
Second Line	:	SUITE 5
City	:	MONROE
State	:	LA
Zip	:	71203-2376
Country	:	US
Telephone Number	:	318-388-8190
Fax Number	:	318-329-5981

Provider Business Practice Location Address
First Line	:	3418 MEDICAL PARK DR
Second Line	:	SUITE 5
City	:	MONROE
State	:	LA
Zip	:	71203-2376
Country	:	US
Telephone Number	:	318-388-8190
Fax Number	:	318-329-5981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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