Healthcare Provider Details

I. General information

NPI: 1073509337
Provider Name (Legal Business Name): ROBERT L BARCLAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROXBURY RD
ROCKFORD IL
61107-5075
US

IV. Provider business mailing address

401 ROXBURY RD
ROCKFORD IL
61107-5075
US

V. Phone/Fax

Practice location:
  • Phone: 815-397-7340
  • Fax: 815-484-7864
Mailing address:
  • Phone: 815-397-7340
  • Fax: 815-397-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number36104379
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC-205058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: