Provider Demographics
NPI:1346687951
Name:CLAYTON FOOT AND ANKLE, P.C.
Entity Type:Organization
Organization Name:CLAYTON FOOT AND ANKLE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SIBRIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-585-6607
Mailing Address - Street 1:118 CRICKET HOLLOW RUN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5922
Mailing Address - Country:US
Mailing Address - Phone:919-585-6607
Mailing Address - Fax:919-585-6648
Practice Address - Street 1:11618 US HWY 70 W
Practice Address - Street 2:108
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2275
Practice Address - Country:US
Practice Address - Phone:919-585-6607
Practice Address - Fax:919-585-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC570213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918668Medicaid
NCNC27120281Medicare PIN
NC5918668Medicaid