Provider Demographics
NPI:1679591481
Name:CLAYTON, CLARENCE G (DPM)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:G
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1077
Mailing Address - Country:US
Mailing Address - Phone:606-783-6950
Mailing Address - Fax:606-783-6910
Practice Address - Street 1:425 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1077
Practice Address - Country:US
Practice Address - Phone:606-784-6551
Practice Address - Fax:606-783-6910
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY309213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80000623Medicaid
KYT61110Medicare UPIN
KY80000623Medicaid