Provider Demographics
NPI:1811214521
Name:ISTRE, CLAY F (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:F
Last Name:ISTRE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 N THUNDERBIRD CIR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1214
Mailing Address - Country:US
Mailing Address - Phone:480-455-4932
Mailing Address - Fax:480-776-0025
Practice Address - Street 1:16755 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2342
Practice Address - Country:US
Practice Address - Phone:210-493-4357
Practice Address - Fax:210-493-4355
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA09534363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343919203Medicaid
TX343919201Medicaid
TX343919202Medicaid
TX343919201Medicaid
TX383546YMN6Medicare PIN
TX383546YLSYMedicare PIN