Provider Demographics
NPI:1700919339
Name:CHRISTOPHER CLAYDON MD
Entity Type:Organization
Organization Name:CHRISTOPHER CLAYDON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLAYDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-271-2100
Mailing Address - Street 1:150 CATHERINE LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5719
Mailing Address - Country:US
Mailing Address - Phone:530-271-2100
Mailing Address - Fax:530-271-2200
Practice Address - Street 1:150 CATHERINE LN
Practice Address - Street 2:SUITE B
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5719
Practice Address - Country:US
Practice Address - Phone:530-271-2100
Practice Address - Fax:530-271-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ255092Medicaid
CAZZZ252742Medicaid
CA00A329080Medicaid
CA00A329080Medicaid
CAZZZ255092Medicaid
CAZZZ252742Medicaid