Provider Demographics
NPI:1285690271
Name:CLAY, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:CLAY
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 1:2767 OLIVE HWY
Mailing Address - Street 2:SUITE 19
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966
Mailing Address - Country:US
Mailing Address - Phone:530-534-1334
Mailing Address - Fax:530-534-0532
Practice Address - Street 1:2767 OLIVE HWY
Practice Address - Street 2:SUITE 19
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6118
Practice Address - Country:US
Practice Address - Phone:530-534-1334
Practice Address - Fax:530-534-0532
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG8051208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G80510Medicaid
CAG8051OtherMEDICAL LICENSE
CA000G80510Medicare ID - Type Unspecified
CA000G80510Medicaid