Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD21763 | OR |
NPI | 1003870536 |
---|---|
Provider Name | Dr. Brad Barlow |
First Address | Ontario, OR 97914-2639 |
Second Address | Ontario, OR 97914-2639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 18/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134320 | (05) | OR |
G80634 | (02) | OR |