Basic Information
Provider Information
NPI: 1033556204
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARCLAY
FirstName: ANDREW
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2000 W BETHANY HOME RD
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850152443
CountryCode: US
TelephoneNumber: 6022465658
FaxNumber:  
Practice Location
Address1: 2000 W BETHANY HOME RD
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850152443
CountryCode: US
TelephoneNumber: 6022465658
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/29/2013
LastUpdateDate: 05/29/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XR2276AZY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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