Provider Demographics
NPI:1740381250
Name:E. ELIZABETH CLAXTON MD, PC
Entity Type:Organization
Organization Name:E. ELIZABETH CLAXTON MD, PC
Other - Org Name:E. ELIZABETH CLAXTON MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CLAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-779-7854
Mailing Address - Street 1:1100 N SAN FRANCISCO ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3260
Mailing Address - Country:US
Mailing Address - Phone:928-779-7854
Mailing Address - Fax:928-774-0508
Practice Address - Street 1:1100 N SAN FRANCISCO ST
Practice Address - Street 2:SUITE B
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3260
Practice Address - Country:US
Practice Address - Phone:928-779-7854
Practice Address - Fax:928-774-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23433207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ392291Medicaid
85520Medicare ID - Type Unspecified
AZ392291Medicaid