Provider Demographics
NPI:1235321126
Name:MCCUAN, CLAYTON A (DO)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:A
Last Name:MCCUAN
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:810 W HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-8602
Practice Address - Country:US
Practice Address - Phone:830-201-7100
Practice Address - Fax:830-201-7336
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5854208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215957601Medicaid
TX215957602Medicaid
TX215957603Medicaid
TX215957603Medicaid
TXTXB147776Medicare PIN
TX215957601Medicaid
TX215957602Medicaid
TXTXB110462Medicare PIN