Provider Demographics
NPI:1639344195
Name:JOHN D. CLAYTON, D.O., P.C.
Entity Type:Organization
Organization Name:JOHN D. CLAYTON, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:812-254-4808
Mailing Address - Street 1:PO BOX 3047
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3047
Mailing Address - Country:US
Mailing Address - Phone:317-614-9641
Mailing Address - Fax:317-713-1261
Practice Address - Street 1:1401 MEMORIAL AVE
Practice Address - Street 2:STE C
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-3153
Practice Address - Country:US
Practice Address - Phone:812-254-4808
Practice Address - Fax:317-713-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDN3965OtherRAILROAD MEDICARE
IN100383020Medicaid
IND46534Medicare UPIN
IN100383020Medicaid