1487626222 NPI number — MR. BRENT JON BARBER M.D.

Table of content: MR. BRENT JON BARBER M.D. (NPI 1487626222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487626222 NPI number — MR. BRENT JON BARBER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARBER
Provider First Name:
BRENT
Provider Middle Name:
JON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1487626222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2701 E ELVIRA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85756-7124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-626-6508
Provider Business Mailing Address Fax Number:
520-626-6571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 N WILMOT RD
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-694-9988
Provider Business Practice Location Address Fax Number:
520-694-9917
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0202X , with the licence number:  32932 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 514910 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZWCGCR . This is a "GROUP MEDICARE NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: P00231035 . This is a "RR MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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