Provider Demographics
NPI:1205192994
Name:CLAIBORNE, PAUL MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:CLAIBORNE
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 1:6600 FISH POND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2582
Mailing Address - Country:US
Mailing Address - Phone:254-776-3188
Mailing Address - Fax:254-776-3607
Practice Address - Street 1:6600 FISH POND RD STE 101
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2582
Practice Address - Country:US
Practice Address - Phone:254-776-3188
Practice Address - Fax:254-776-3607
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR2307208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program