Provider Demographics
NPI:1750372280
Name:CLAY, JAMES E (DO)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:CLAY
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1525 MADISON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-1703
Mailing Address - Country:US
Mailing Address - Phone:620-378-3700
Mailing Address - Fax:620-378-3536
Practice Address - Street 1:1525 MADISON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1703
Practice Address - Country:US
Practice Address - Phone:620-378-3700
Practice Address - Fax:620-378-3536
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2013-07-31
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Provider Licenses
StateLicense IDTaxonomies
KS05-16904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098540AMedicaid
178544OtherMEDICARE
T77456Medicare UPIN