Provider Demographics
NPI:1114035367
Name:CLAXTON, CARL D (DO)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:D
Last Name:CLAXTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 JOHNSTOWN DR
Mailing Address - Street 2:#540
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-9366
Mailing Address - Country:US
Mailing Address - Phone:417-753-7757
Mailing Address - Fax:417-501-4392
Practice Address - Street 1:1925 W CHESTERFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-8686
Practice Address - Country:US
Practice Address - Phone:417-269-0269
Practice Address - Fax:417-269-0279
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240437921Medicaid
24806OtherBLUE CROSS
P00375463Medicare PIN
080137726Medicare PIN
24806OtherBLUE CROSS
D41703Medicare UPIN