Provider Demographics
NPI:1609848894
Name:CLAYTON, CHARLES LAMAR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LAMAR
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 VINELAND LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-7924
Mailing Address - Country:US
Mailing Address - Phone:850-519-1113
Mailing Address - Fax:850-656-5549
Practice Address - Street 1:1848 VINELAND LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-7924
Practice Address - Country:US
Practice Address - Phone:850-519-1113
Practice Address - Fax:850-656-5549
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1859402367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305526400Medicaid
FLG0150OtherBLUE CROSS
FLP00352522OtherRAILROAD MEDICARE
FL305526400Medicaid