1841389038 NPI number — PETRA BARCLAY DDS, MSD

Table of content: PETRA BARCLAY DDS, MSD (NPI 1841389038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841389038 NPI number — PETRA BARCLAY DDS, MSD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARCLAY
Provider First Name:
PETRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS, MSD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841389038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1959 NE PACIFIC ST
Provider Second Line Business Mailing Address:
PO BOX 357131
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98195-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-685-2937
Provider Business Mailing Address Fax Number:
206-616-8577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1959 NE PACIFIC ST
Provider Second Line Business Practice Location Address:
HSB - B221
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-685-2937
Provider Business Practice Location Address Fax Number:
206-616-8577
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DE00008073 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5032933 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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