Provider Demographics
NPI:1609841691
Name:CLAYTON, JOHN D (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 COMMERCE CROSSING, 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229
Mailing Address - Country:US
Mailing Address - Phone:502-253-4924
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:2125 STATE ST STE 3
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4972
Practice Address - Country:US
Practice Address - Phone:812-949-5575
Practice Address - Fax:812-949-5595
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001159208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN020043317OtherRAILROAD MEDICARE
ININ1189122OtherIN MEDICARE
IN100383020Medicaid
IN100383020Medicaid
INM400060928Medicare Oscar/Certification
IN143070AMedicare PIN