Provider Demographics
NPI:1346408820
Name:EVERLINE, CLAYTON AUSTIN (MD, FACP, FAWM, CSCS)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:AUSTIN
Last Name:EVERLINE
Suffix:
Gender:M
Credentials:MD, FACP, FAWM, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68-615 FARRINGTON HWY
Mailing Address - Street 2:21A
Mailing Address - City:WAIALUA
Mailing Address - State:HI
Mailing Address - Zip Code:96791-9377
Mailing Address - Country:US
Mailing Address - Phone:808-676-5331
Mailing Address - Fax:
Practice Address - Street 1:68-615 FARRINGTON HWY
Practice Address - Street 2:21A
Practice Address - City:WAIALUA
Practice Address - State:HI
Practice Address - Zip Code:96791-9377
Practice Address - Country:US
Practice Address - Phone:808-676-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432642207RS0010X
HIMD15206207RS0010X
NY252471207RS0010X
NJ25MA08368700207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI139730L6FMedicare UPIN
DN377ZMedicare PIN