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NPI Code Detail

MEDICARE: BARRY JOHN CLEMENTS PA-C

MEDICARE: BARRY JOHN CLEMENTS PA-C
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1952392177
Entity Type Code : Individual
Provider Name (Legal Business Name) : BARRY JOHN CLEMENTS PA-C
Provider Business Mailing Address
First Line : 1201 GLEN COVE PKWY
Second Line : #1109
City : VALLEJO
State : CA
Zip : 94591-7171
Country : US
Telephone Number : 800-346-0747
Fax Number :
Provider Business Practice Location Address
First Line : 20103 LAKE CHABOT RD
Second Line :
City : CASTRO VALLEY
State : CA
Zip : 94546-5341
Country : US
Telephone Number : 510-889-5015
Fax Number : 510-881-1473
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 10/16/2012

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Directions to “ BARRY JOHN CLEMENTS PA-C” Practice Location

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