Provider Demographics
NPI:1033560867
Name:JOHN M BARNES DPM LLC
Entity type:Organization
Organization Name:JOHN M BARNES DPM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-297-2222
Mailing Address - Street 1:506 NE 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2928
Mailing Address - Country:US
Mailing Address - Phone:503-297-2222
Mailing Address - Fax:
Practice Address - Street 1:9615 NW RANDALL LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5294
Practice Address - Country:US
Practice Address - Phone:503-297-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00328213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U89515Medicare UPIN