Provider Demographics
NPI:1396194882
Name:BARCLAY WHITE, BARCLAY JOHN GREGSON
Entity Type:Individual
Prefix:
First Name:BARCLAY JOHN
Middle Name:GREGSON
Last Name:BARCLAY WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6853 E OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6211
Mailing Address - Country:US
Mailing Address - Phone:480-526-6077
Mailing Address - Fax:480-765-2197
Practice Address - Street 1:6853 E OSBORN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6211
Practice Address - Country:US
Practice Address - Phone:480-526-6077
Practice Address - Fax:480-765-2197
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8012H164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse