Provider Demographics
NPI:1871854554
Name:NELSON, CLAYTON ELLIS (MD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:ELLIS
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N LEE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2612
Mailing Address - Country:US
Mailing Address - Phone:405-218-2530
Mailing Address - Fax:405-218-2535
Practice Address - Street 1:1110 N LEE AVE STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2612
Practice Address - Country:US
Practice Address - Phone:405-218-2530
Practice Address - Fax:405-218-2535
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD461592207X00000X, 207XS0106X
OK29279207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200445900AMedicaid