Provider Demographics
NPI:1669435947
Name:SHOWALTER, BARBARA MOON (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:MOON
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3144 G ST
Mailing Address - Street 2:#125-334
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-1300
Mailing Address - Country:US
Mailing Address - Phone:209-723-7761
Mailing Address - Fax:209-381-0322
Practice Address - Street 1:2039 CANAL ST
Practice Address - Street 2:SUITE C
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-3726
Practice Address - Country:US
Practice Address - Phone:209-723-7761
Practice Address - Fax:209-381-0322
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2009-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG063855207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770320287OtherTAX ID
CA00G638550Medicaid
CA00G638550Medicaid
CA00G638551Medicare PIN