Provider Demographics
NPI:1073693800
Name:BARKER, JOHN CLAYTON (MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CLAYTON
Last Name:BARKER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15995 TUSCOLA RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2159
Mailing Address - Country:US
Mailing Address - Phone:760-242-2388
Mailing Address - Fax:760-242-2312
Practice Address - Street 1:15995 TUSCOLA RD
Practice Address - Street 2:SUITE 208
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2159
Practice Address - Country:US
Practice Address - Phone:760-242-2388
Practice Address - Fax:760-242-2312
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1897237700000X
CAAU315231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0001OtherTRIWEST-CHAMPUS
CAZZZ756844ZMedicaid
CAZZZ756844ZMedicaid