Provider Demographics
NPI:1487746509
Name:BARKSDALE, PHILLIP ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:BARKSDALE
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 1:500 RUE DE LA VIE ST
Mailing Address - Street 2:SUITE 511
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5127
Mailing Address - Country:US
Mailing Address - Phone:225-752-3000
Mailing Address - Fax:225-752-8900
Practice Address - Street 1:500 RUE DE LA VIE ST
Practice Address - Street 2:SUITE 511
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5127
Practice Address - Country:US
Practice Address - Phone:225-752-3000
Practice Address - Fax:225-752-8900
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09178R207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA198110Medicaid
LA5W210Medicare ID - Type Unspecified
LAG06417Medicare UPIN