Provider Demographics
NPI:1558406710
Name:BARCLAY, PAULA JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:JANE
Last Name:BARCLAY
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:PO BOX 2600
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-2600
Mailing Address - Country:US
Mailing Address - Phone:970-927-3142
Mailing Address - Fax:970-927-3302
Practice Address - Street 1:0381 SOUTHSIDE DR
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-9170
Practice Address - Country:US
Practice Address - Phone:979-927-3142
Practice Address - Fax:970-927-3302
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31113174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01311133Medicaid
CO01311133Medicaid
CO01311133Medicaid
BB0672647OtherDEA NUMBER