Provider Demographics
NPI:1881604353
Name:RILEY, STEVEN CLAYTON (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CLAYTON
Last Name:RILEY
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 1:1340 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4724
Mailing Address - Country:US
Mailing Address - Phone:432-332-2663
Mailing Address - Fax:432-337-0910
Practice Address - Street 1:1340 E 7TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79760
Practice Address - Country:US
Practice Address - Phone:432-332-2663
Practice Address - Fax:432-337-0910
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0761207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135556206Medicaid
TX181001200OtherDEPT OF LABOR
TXMDH0761OtherWORKMENS COMPENSATION
TX83551GOtherBCBS
TX200032830OtherRAILROAD MCR
TX122514100OtherSOUTHWEST LIFE & HEALTH
TX4217928OtherAETNA
TX81781JMedicare ID - Type UnspecifiedMCR
TX4217928OtherAETNA