Provider Demographics
NPI:1134212756
Name:BARCLAY, RANDY ALAN (PA)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:ALAN
Last Name:BARCLAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2207
Mailing Address - Country:US
Mailing Address - Phone:559-685-3411
Mailing Address - Fax:559-685-3864
Practice Address - Street 1:869 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2207
Practice Address - Country:US
Practice Address - Phone:559-685-3411
Practice Address - Fax:559-685-3864
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13659364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA136590Medicare ID - Type Unspecified
P08615Medicare UPIN