Provider Demographics
NPI:1619968021
Name:CLAYSON, DARBY ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:DARBY
Middle Name:ANNETTE
Last Name:CLAYSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SULLIVAN AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015
Mailing Address - Country:US
Mailing Address - Phone:415-680-4135
Mailing Address - Fax:702-453-5741
Practice Address - Street 1:1900 SULLIVAN AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015
Practice Address - Country:US
Practice Address - Phone:415-680-4135
Practice Address - Fax:702-453-5741
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11502171000000X, 207R00000X
CAA139455207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV102339Medicare PIN