Healthcare Provider Details

I. General information

NPI: 1104894336
Provider Name (Legal Business Name): BRAD CLAYTON BARTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BAILEY AVE
NEEDLES CA
92363-3103
US

IV. Provider business mailing address

1401 BAILEY AVE
NEEDLES CA
92363-3103
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-7141
  • Fax: 760-326-7167
Mailing address:
  • Phone: 760-326-7141
  • Fax: 760-326-7167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA66743
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA66743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: