Provider Demographics
NPI:1104894336
Name:BARTH, BRAD CLAYTON (MD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:CLAYTON
Last Name:BARTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-3103
Mailing Address - Country:US
Mailing Address - Phone:760-326-7141
Mailing Address - Fax:760-326-7167
Practice Address - Street 1:1401 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-3103
Practice Address - Country:US
Practice Address - Phone:760-326-7141
Practice Address - Fax:760-326-7167
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66743207L00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A667430Medicaid
AZ443341Medicaid
AZ443341Medicaid