Provider Demographics
NPI:1083837348
Name:CLANTON, BARRY ALAN (PA C)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:ALAN
Last Name:CLANTON
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 E 850 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2989
Mailing Address - Country:US
Mailing Address - Phone:850-819-5033
Mailing Address - Fax:801-375-2172
Practice Address - Street 1:75 S 200 E STE 202
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3168
Practice Address - Country:US
Practice Address - Phone:801-375-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant