Provider Demographics
NPI:1477502862
Name:BARCLAY, SCOTT I (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:I
Last Name:BARCLAY
Suffix:
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 1:610 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-1146
Mailing Address - Country:US
Mailing Address - Phone:720-394-4537
Mailing Address - Fax:
Practice Address - Street 1:1300 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-1048
Practice Address - Country:US
Practice Address - Phone:618-443-1337
Practice Address - Fax:618-443-1383
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA40602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA560910024OtherMEDICARE PTAN
COD24616Medicare UPIN
COC452088Medicare PIN