Doctor Name: | MR. MARK BARNES |
NPI Number: | 1043572407 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CNIM, R. EP T |
License Number: | |
Business Practice Address: | 3319 E Gillette St Broken Arrow, OK - 740148754 |
Business Phone Number: | 9188094479 |
Business Fax Number: | |
Mailing Address: | 3319 E Gillette St, BROKEN ARROW |
State: | OK |
Postal Code: | 740148754 |
Phone Number: | 9188094479 |
Fax Number: | |
NPI Enumeration Date: | 06/12/2012 |
NPI Last Update Date: | 06/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246ZE0600X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Specialist/Technologist, Other |
Taxonomy Specialization: | Electroneurodiagnostic |
Taxonomy Definition: |