Basic Information
Provider Information | |||||||||
NPI: | 1649254640 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARNES | ||||||||
FirstName: | CRAIG | ||||||||
MiddleName: | E | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3200 E CAMELBACK RD STE 250 | ||||||||
Address2: |   | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850182327 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6029331813 | ||||||||
FaxNumber: | 6029331820 | ||||||||
Practice Location | |||||||||
Address1: | 1919 E THOMAS RD | ||||||||
Address2: | EAST BUILDING | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850167710 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6029331213 | ||||||||
FaxNumber: | 6029331214 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/02/2005 | ||||||||
LastUpdateDate: | 01/23/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085P0229X | 33608 | NC | N |   | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | 41001 | AZ | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085P0229X | 41001 | AZ | Y |   | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology |
ID Information
ID | Type | State | Issuer | Description | 1285R | 01 |   | BCBS | OTHER | A8339 | 01 |   | MEDCOST | OTHER | 41103 | 01 |   | PARTNERS | OTHER | 7169329 | 01 |   | AETNA | OTHER | 891285R | 05 | NC |   | MEDICAID | Q33608 | 05 | SC |   | MEDICAID | 2001043000 | 05 | WV |   | MEDICAID | 7204060 | 05 | VA |   | MEDICAID |