Provider Demographics
NPI:1376598342
Name:CLAYTON, JUDY PICKETT (DO)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:PICKETT
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:PICKETT
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO,
Mailing Address - Street 1:201 E ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-7119
Mailing Address - Country:US
Mailing Address - Phone:325-235-8641
Mailing Address - Fax:325-235-5925
Practice Address - Street 1:201 E ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-7119
Practice Address - Country:US
Practice Address - Phone:325-235-8641
Practice Address - Fax:325-235-5925
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89W540Medicare ID - Type UnspecifiedMEDICARE #
TXD97274Medicare UPIN