Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 2012011802 | MO |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101017309 | MI |
NPI | 1316144223 |
---|---|
Provider Name | Dr. John Judson Barclay JR. |
First Address | Liberty, MO 64068-3388 |
Second Address | Liberty, MO 64068-3388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 11/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47486021 | BCBS (01) | MO |
P01085873 | RR MEDCIARE (01) | MO |