Provider Demographics
NPI:1720080724
Name:SAWYER, J CLAY (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:CLAY
Last Name:SAWYER
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 1:305 LONDONDERRY DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7929
Mailing Address - Country:US
Mailing Address - Phone:254-776-1421
Mailing Address - Fax:254-776-1711
Practice Address - Street 1:305 LONDONDERRY DR
Practice Address - Street 2:SUITE 6
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7906
Practice Address - Country:US
Practice Address - Phone:254-776-1421
Practice Address - Fax:254-776-1711
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG37632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JZ91000000OtherBCBS OF TEXAS
TX00JZ91000000OtherBCBS OF TEXAS