Provider Demographics
NPI:1609950831
Name:LANPHEAR, CLAYTON D III (DO)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:D
Last Name:LANPHEAR
Suffix:III
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 1:1133 MAIN ST
Mailing Address - Street 2:PO BOX Q
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814
Mailing Address - Country:US
Mailing Address - Phone:401-568-6658
Mailing Address - Fax:
Practice Address - Street 1:1133 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEPACHET
Practice Address - State:RI
Practice Address - Zip Code:02814
Practice Address - Country:US
Practice Address - Phone:401-568-6658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003608Medicaid
RI050391083OtherUHC
3608-1OtherBCBS
129003608Medicare ID - Type Unspecified
3608-1OtherBCBS