Provider Demographics
NPI:1578646345
Name:BUNT, CLAYTON JAMES (MD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:JAMES
Last Name:BUNT
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 1:21634 ANGEL POINT LN
Mailing Address - Street 2:
Mailing Address - City:PECK
Mailing Address - State:ID
Mailing Address - Zip Code:83545-8045
Mailing Address - Country:US
Mailing Address - Phone:208-486-6063
Mailing Address - Fax:
Practice Address - Street 1:301 CEDAR ST
Practice Address - Street 2:CLEARWATER VALLEY HOSPITAL & CLINICS
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9029
Practice Address - Country:US
Practice Address - Phone:208-476-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-9739207Q00000X
WYA4684207Q00000X
MT5069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807606600Medicaid
MTD93527Medicare UPIN