Provider Demographics
NPI:1689667826
Name:PICKERING, CLAYTON (DO)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:
Last Name:PICKERING
Suffix:
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 1:202 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-2398
Mailing Address - Country:US
Mailing Address - Phone:254-694-2221
Mailing Address - Fax:254-694-9978
Practice Address - Street 1:202 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2398
Practice Address - Country:US
Practice Address - Phone:254-694-2221
Practice Address - Fax:254-694-9978
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118498805Medicaid
TX00750UMedicare PIN
TXH09485Medicare UPIN
TX8A3913Medicare PIN