Provider Demographics
NPI:1629018445
Name:PAVLIS, CLAY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:JOSEPH
Last Name:PAVLIS
Suffix:
Gender:M
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 1:809 W PIPESTONE AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:FLANDREAU
Mailing Address - State:SD
Mailing Address - Zip Code:57028
Mailing Address - Country:US
Mailing Address - Phone:507-337-0556
Mailing Address - Fax:507-337-0567
Practice Address - Street 1:809 W PIPESTONE AVE STE 8
Practice Address - Street 2:
Practice Address - City:FLANDREAU
Practice Address - State:SD
Practice Address - Zip Code:57028
Practice Address - Country:US
Practice Address - Phone:507-337-0556
Practice Address - Fax:507-337-0567
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN473582084P0800X
SD70352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS101822Medicare PIN