Provider Demographics
NPI:1174563860
Name:BARNARD, MARK LUTHER (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:LUTHER
Last Name:BARNARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:506 EAST CHEVES STREET
Mailing Address - Street 2:P.O. BOX 1905
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29503-1905
Mailing Address - Country:US
Mailing Address - Phone:843-413-3100
Mailing Address - Fax:843-413-3197
Practice Address - Street 1:506 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2616
Practice Address - Country:US
Practice Address - Phone:843-413-3100
Practice Address - Fax:843-413-3197
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12671207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890501JMedicaid
SC126713Medicaid
SCC61322Medicare UPIN