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Individual
RANDY BARNES
Active
Individual
RANDY BARNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002006
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D14869
GROUP MEDICARE PTAN
MI
Enumeration date
06/14/2006
Last updated
06/28/2016
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