Provider Demographics
NPI:1588815286
Name:CLAY, CLARENCE HENRY IV (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:HENRY
Last Name:CLAY
Suffix:IV
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 1:1110 S MOODY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-4725
Mailing Address - Country:US
Mailing Address - Phone:727-452-3066
Mailing Address - Fax:
Practice Address - Street 1:18167 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 650
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-3528
Practice Address - Country:US
Practice Address - Phone:727-507-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109382207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine