Provider Demographics
NPI:1538138763
Name:COON, CLAYTON COLLINS (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:COLLINS
Last Name:COON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:611 GRAMMONT ST.
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7516
Mailing Address - Country:US
Mailing Address - Phone:318-325-2634
Mailing Address - Fax:318-812-1205
Practice Address - Street 1:102 THOMAS RD.
Practice Address - Street 2:SUITE 114
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7365
Practice Address - Country:US
Practice Address - Phone:318-812-3303
Practice Address - Fax:318-812-3304
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA021320207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1680435Medicaid
LA1680435Medicaid
LAG23089Medicare UPIN