Provider Demographics
NPI:1982933040
Name:ANDERSON, CLAIR BARTON JR (PA)
Entity type:Individual
Prefix:MR
First Name:CLAIR
Middle Name:BARTON
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 NORTH SPRING STREET
Mailing Address - Street 2:P O BOX 1010
Mailing Address - City:CALIENTE
Mailing Address - State:NV
Mailing Address - Zip Code:89008-1010
Mailing Address - Country:US
Mailing Address - Phone:775-726-3171
Mailing Address - Fax:775-726-3797
Practice Address - Street 1:700 NORTH SPRING STREET
Practice Address - Street 2:
Practice Address - City:CALIENTE
Practice Address - State:NV
Practice Address - Zip Code:89008-1010
Practice Address - Country:US
Practice Address - Phone:775-726-3171
Practice Address - Fax:775-726-3797
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1188363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA1188OtherNEVADA LICENSE