Provider Demographics
NPI:1134199623
Name:BARCLAY, SCOTT WADE (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WADE
Last Name:BARCLAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W 11TH PL
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-4119
Mailing Address - Country:US
Mailing Address - Phone:432-264-6361
Mailing Address - Fax:432-268-4590
Practice Address - Street 1:1501 W 11TH PL
Practice Address - Street 2:SUITE 206
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4119
Practice Address - Country:US
Practice Address - Phone:432-264-6361
Practice Address - Fax:432-268-4590
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BE674OtherBCBS OF TX
TX044450703 (SMMC)Medicaid
TX044450702Medicaid
TX044450703 (SMMC)Medicaid
TX8C8063Medicare ID - Type Unspecified
TX044450702Medicaid