Provider Demographics
NPI:1063411056
Name:BARNES, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:BARNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 MEDICAL PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2388
Mailing Address - Country:US
Mailing Address - Phone:318-325-6078
Mailing Address - Fax:318-324-9694
Practice Address - Street 1:3400 MEDICAL PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2388
Practice Address - Country:US
Practice Address - Phone:318-325-6078
Practice Address - Fax:318-324-9694
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2021-07-14
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
LAMD.015532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA010018043OtherRAILROAD MEDICARE
LA1330469Medicaid
LA5J252Medicare ID - Type Unspecified
LA1330469Medicaid