Provider Demographics
NPI:1316366818
Name:COMMANDER, CLAYTON WARREN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:WARREN
Last Name:COMMANDER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8375 DIX ELLIS TRL STE 201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8241
Mailing Address - Country:US
Mailing Address - Phone:904-399-5810
Mailing Address - Fax:
Practice Address - Street 1:8375 DIX ELLIS TRL STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8241
Practice Address - Country:US
Practice Address - Phone:904-399-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008892085R0202X, 2085R0204X
FLME1632242085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty