Provider Demographics
NPI:1518547496
Name:TAYLOR, CLAYTON
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 N CAPITOL AVE STE 640
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1281
Mailing Address - Country:US
Mailing Address - Phone:317-962-8881
Mailing Address - Fax:317-962-0838
Practice Address - Street 1:1633 N CAPITOL AVE STE 640
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1281
Practice Address - Country:US
Practice Address - Phone:317-962-8881
Practice Address - Fax:317-962-0838
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program