Provider Demographics
NPI:1457466989
Name:CLAXTON, MATTHEW JAY (DPM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAY
Last Name:CLAXTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 S CLOVERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6438
Mailing Address - Country:US
Mailing Address - Phone:636-928-1240
Mailing Address - Fax:636-928-1242
Practice Address - Street 1:4201 S CLOVERLEAF DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6438
Practice Address - Country:US
Practice Address - Phone:636-928-1240
Practice Address - Fax:636-928-1242
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003013610213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005131Medicaid
MO309013308Medicaid
MOP00171525OtherRAILROAD MEDICARE
ILK02926Medicare PIN
ILU97876Medicare UPIN
IL016005131Medicaid
IL5031350002Medicare NSC
MO246114113Medicare PIN