Provider Demographics
NPI:1083610505
Name:CLAYCOMB, SCOTT C (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:CLAYCOMB
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 1:301 HIGHWAY 425 S
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4611
Mailing Address - Country:US
Mailing Address - Phone:870-367-8534
Mailing Address - Fax:870-367-0264
Practice Address - Street 1:301 HIGHWAY 425 S
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4611
Practice Address - Country:US
Practice Address - Phone:870-367-8534
Practice Address - Fax:870-367-0264
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7907207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
16703OtherQUALCHOICE
AR1180870001Medicaid
AR128298002Medicaid
AR54339OtherBLUE CROSS OF AR
AR118087001Medicaid
AR180024861OtherRAILROAD MEDICARE
AR54339Medicare ID - Type Unspecified
ARE66048Medicare PIN