Provider Demographics
NPI:1154316453
Name:CLAY, JEAN MEREDITH (DPM)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MEREDITH
Last Name:CLAY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 BULIFANTS BLVD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-3409
Mailing Address - Country:US
Mailing Address - Phone:757-220-3338
Mailing Address - Fax:757-220-8809
Practice Address - Street 1:302 BULIFANTS BLVD.
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-3409
Practice Address - Country:US
Practice Address - Phone:757-220-3338
Practice Address - Fax:757-220-8809
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001049213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA480000645Medicare PIN
VAU66215Medicare UPIN