Provider Demographics
NPI:1235371840
Name:SMITH, CLAYTON MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:MICHAEL
Last Name:SMITH
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 1:401 E CHESTNUT ST
Mailing Address - Street 2:STE #310
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5700
Mailing Address - Country:US
Mailing Address - Phone:502-813-6500
Mailing Address - Fax:
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:STE #310
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-813-6500
Practice Address - Fax:502-589-5093
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100140140Medicaid
IN201178490Medicaid
KY000000674798OtherANTHEM - NICC
KY136454OtherSIHO - NICC
KY7100140140Medicaid