Basic Information
Provider Information | |||||||||
NPI: | 1437163987 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARTON | ||||||||
FirstName: | CHESTER | ||||||||
MiddleName: | PARK | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: | III | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 55 MDG | ||||||||
Address2: | 2501 CAPEHART RD | ||||||||
City: | OFFUTT AFB | ||||||||
State: | NE | ||||||||
PostalCode: | 68113 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4022947376 | ||||||||
FaxNumber: | 4022949099 | ||||||||
Practice Location | |||||||||
Address1: | 4439 STATE ROUTE 159 STE G70 | ||||||||
Address2: |   | ||||||||
City: | CHILLICOTHE | ||||||||
State: | OH | ||||||||
PostalCode: | 456017203 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7407794393 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/28/2006 | ||||||||
LastUpdateDate: | 07/21/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/21/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | MD47915 | IA | N |   | Allopathic & Osteopathic Physicians | Otolaryngology |   | 207Y00000X | 30482 | NE | N |   | Allopathic & Osteopathic Physicians | Otolaryngology |   | 207Y00000X | MD.024105 | LA | Y |   | Allopathic & Osteopathic Physicians | Otolaryngology |   |
No ID Information.