Provider Demographics
NPI:1235190182
Name:BROWN, CLAYTON G (MD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:G
Last Name:BROWN
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 1:3775 PIPER RD
Mailing Address - Street 2:
Mailing Address - City:SLAUGHTER
Mailing Address - State:LA
Mailing Address - Zip Code:70777-9635
Mailing Address - Country:US
Mailing Address - Phone:225-654-0027
Mailing Address - Fax:225-654-0052
Practice Address - Street 1:4727 W PARK DR STE A
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4090
Practice Address - Country:US
Practice Address - Phone:225-654-0027
Practice Address - Fax:225-654-0052
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.014714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1310484Medicaid
B62433Medicare UPIN
LA1310484Medicaid