Mary Lois Barnes, D.O.
Individual provider Active NPI Pediatrics Physician · Lander, WY
NPI 1679674246 · NPPES record last updated Jan 3, 2012
Key facts
- NPI
- 1679674246
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 5773A (WY)
- Practice address
- 115 Wyoming St
Lander, WY 82520-3919 - Phone
- (307) 332-2185
- Fax
- (307) 322-7799
- NPI assigned
- Sep 26, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5773A | WY | MD | Pediatrics Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 5773A | WY | Yes |
Addresses
Primary practice location
115 Wyoming St
Lander, WY 82520-3919
Mailing address
115 Wyoming St
Lander, WY 82520-3919
Phone (307) 332-2185
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 504824210005 | Medicaid | UT | |
| 111667300 | Medicaid | WY | |
| 295833 | Other | WY | ALTIUS |
| 303923 | Other | WY | BLUE CROSS |
Other providers in Lander, WY
- Estelle Marie Baker
- Nichole Baker
- Susan Jean Baker
- Tania Leigh Baker
- Stephanie Bales
- Mary Rachael Barnes
- Richard E. Barnes
- Amanda Barrett
- Mina Barrett
- Alexis Bartolucci
All providers in Lander, WY · Pediatrics Physician in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.