Provider Demographics
NPI:1124010335
Name:BREDLAU, CLAYTON E (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:E
Last Name:BREDLAU
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:PO BOX 5699
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-5699
Mailing Address - Country:US
Mailing Address - Phone:941-365-0433
Mailing Address - Fax:941-954-2064
Practice Address - Street 1:1215 S EAST AVE STE 303
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2354
Practice Address - Country:US
Practice Address - Phone:941-365-0433
Practice Address - Fax:941-954-2064
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47532207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047171200Medicaid
FL060069360OtherMEDICARE RR
FL58494OtherBCBS
FL060069360OtherMEDICARE RR
FL047171200Medicaid