MEDICARE: VIVEK BARCLAY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	16318	MS
2	208VP0014X	Interventional Pain Medicine Physician	16318	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	412044822	OTHER	MS	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1578594586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVEK BARCLAY MD

Provider Business Mailing Address
First Line	:	1710 W 12TH ST
Second Line	:
City	:	LAUREL
State	:	MS
Zip	:	39440-2559
Country	:	US
Telephone Number	:	601-369-2021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 W 12TH ST
Second Line	:
City	:	LAUREL
State	:	MS
Zip	:	39440-2559
Country	:	US
Telephone Number	:	601-369-2021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	05/18/2011

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Directions to “ VIVEK BARCLAY MD” Practice Location

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