Provider Demographics
NPI:1295909901
Name:CLAYTON, DANIEL ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALEXANDER
Last Name:CLAYTON
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:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-366-2983
Mailing Address - Fax:
Practice Address - Street 1:1717 13TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1621
Practice Address - Country:US
Practice Address - Phone:425-297-6400
Practice Address - Fax:425-297-6405
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCTRAINING LICENSE207T00000X
WA60081909207T00000X
WI54287207T00000X
MN52761207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAENROLLEDMedicaid
WAMD60081909OtherWSL
IAENROLLEDMedicaid
MN140000487Medicare PIN