Provider Demographics
NPI:1477520732
Name:RENFRO, CLAY ARLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:ARLEN
Last Name:RENFRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 PRINCETON ROAD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2062
Mailing Address - Country:US
Mailing Address - Phone:423-975-2200
Mailing Address - Fax:423-975-2210
Practice Address - Street 1:219 PRINCETON ROAD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2062
Practice Address - Country:US
Practice Address - Phone:423-975-2200
Practice Address - Fax:423-975-2210
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4122287OtherBLUE CROSS BLUE SHIELD
P00294810OtherRAILROAD MEDICARE
TN4122287OtherBCBST
TN3123766Medicaid
P00294810OtherRAILROAD MEDICARE
TN4122287OtherBLUE CROSS BLUE SHIELD
3703862Medicare PIN
TN3123766Medicaid
TN4122287OtherBCBST
3123766Medicare ID - Type Unspecified