Provider Demographics
NPI:1952392177
Name:CLEMENTS, BARRY JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:JOHN
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GLEN COVE PKWY
Mailing Address - Street 2:#1109
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7171
Mailing Address - Country:US
Mailing Address - Phone:800-346-0747
Mailing Address - Fax:
Practice Address - Street 1:20103 LAKE CHABOT RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5341
Practice Address - Country:US
Practice Address - Phone:510-889-5015
Practice Address - Fax:510-881-1473
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant