1932281623 NPI number — WILLIAM R BARKMAN DO PC

Table of content: (NPI 1932281623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932281623 NPI number — WILLIAM R BARKMAN DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM R BARKMAN DO PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932281623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 LLANO STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AZTEC
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87410-2172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-334-9441
Provider Business Mailing Address Fax Number:
505-334-8750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 LLANO STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AZTEC
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87410-2172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-334-9441
Provider Business Practice Location Address Fax Number:
505-334-8750
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARKMAN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
505-334-9441

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A71780 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: A130105 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3856 . This is a "LOVELACE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM014038 . This is a "BLUE CROSS BLUE SHIELD NM" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 11312PHP . This is a "PHP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 42812 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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