Provider Demographics
NPI:1376175794
Name:CLAYPOOL, JAMES ERNEST (IDC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ERNEST
Last Name:CLAYPOOL
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12411 GLENN HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2349
Mailing Address - Country:US
Mailing Address - Phone:804-895-3665
Mailing Address - Fax:
Practice Address - Street 1:12411 GLENN HOLLOW DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-2349
Practice Address - Country:US
Practice Address - Phone:804-895-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Single Specialty