Provider Demographics
NPI:1518938661
Name:BARON, KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BARON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W BULLARD AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0861
Mailing Address - Country:US
Mailing Address - Phone:559-297-1300
Mailing Address - Fax:
Practice Address - Street 1:255 W BULLARD AVE
Practice Address - Street 2:STE 124
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0861
Practice Address - Country:US
Practice Address - Phone:559-297-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G31933OtherBLUE CROSS
CA00G31933OtherAETNA
CA00G31933OtherUNITED HEALTH CARE
CA553943OtherMEDICARE
CA00G31933OtherBLUE SHIELD
CA00G31933OtherMEDICARE PROVIDER NUMBER
CARHM53811GMedicaid
CAGR0066340Medicaid
CA553811OtherMEDICARE
CAGR0066343Medicaid
CAGR0066345Medicaid
CARHM53943FMedicaid
CA00G31933OtherBLUE CROSS
CA553811OtherMEDICARE
CA1518938661Medicare Oscar/Certification