Provider Demographics
NPI:1326137589
Name:BARBOUR, CLAYTON O II (MD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:O
Last Name:BARBOUR
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12520 PALM DR
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-4559
Mailing Address - Country:US
Mailing Address - Phone:760-676-5800
Mailing Address - Fax:858-634-6960
Practice Address - Street 1:68555 RAMON RD
Practice Address - Street 2:SUITE D103 & D104
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-9223
Practice Address - Country:US
Practice Address - Phone:760-507-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G739850Medicaid
CA00G739850Medicaid
CA00G739850Medicare ID - Type UnspecifiedCLAYTON O BARBOUR, II, MD
CA00G739850Medicaid