Provider Demographics
NPI:1700503554
Name:ANDERSON, CLAYTON (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:ANDERSON
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 1:4665 N US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-8558
Mailing Address - Country:US
Mailing Address - Phone:812-376-9353
Mailing Address - Fax:
Practice Address - Street 1:4665 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-8558
Practice Address - Country:US
Practice Address - Phone:812-376-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant