Provider Demographics
NPI:1861479669
Name:CLAY, JAMES G (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:CLAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:4310 LEONARD ST NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534
Mailing Address - Country:US
Mailing Address - Phone:616-453-6329
Mailing Address - Fax:616-453-1725
Practice Address - Street 1:669 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-7903
Practice Address - Country:US
Practice Address - Phone:616-457-7171
Practice Address - Fax:616-457-1121
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901001439213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480006462OtherRR MEDICARE
MI340402Medicaid
JC001439OtherBLUE CROSS
JC001439OtherBLUE CROSS
MI340402Medicaid
0307890001Medicare NSC