Provider Demographics
NPI:1538318951
Name:CLAYTON, PAUL BALLARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BALLARD
Last Name:CLAYTON
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-387-7945
Mailing Address - Fax:801-387-7948
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:SUITE 2835
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3271
Practice Address - Country:US
Practice Address - Phone:801-387-7945
Practice Address - Fax:801-387-7948
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5117029-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1538318951Medicaid
UT000069896Medicare PIN