Provider Demographics
NPI:1295811867
Name:BARNES, RANDY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:LEE
Last Name:BARNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3277 E LOUISE DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9360
Mailing Address - Country:US
Mailing Address - Phone:208-489-5800
Mailing Address - Fax:208-489-4065
Practice Address - Street 1:3277 E LOUISE DR STE 410
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9360
Practice Address - Country:US
Practice Address - Phone:208-489-5800
Practice Address - Fax:208-489-4065
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9867207P00000X
IDM-9867207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808349300Medicaid
CA00A889180Medicaid
ID808349300Medicaid
CA00A889180Medicare PIN