Healthcare Provider Details

I. General information

NPI: 1528001591
Provider Name (Legal Business Name): SCOTT J. BARLOW PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 NW SAMARITAN DR SUITE 201
CORVALLIS OR
97330-3783
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-5930
  • Fax: 541-768-5935
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00867
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: