MEDICARE: CLAY B BRASHEARS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	E-1155	AR
2	207R00000X	Internal Medicine Physician	E-1155	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00063917	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7995117	OTHER	AR	AETNA
2	18428000000	OTHER	AR	QUALCHOICE
3	1941357	OTHER	AR	UNITED HEALTHCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	26654584	OTHER	AR	CIGNA

General Provider Information

NPI Number	:	1265430201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAY B BRASHEARS M.D.

Provider Business Mailing Address
First Line	:	722 N MAIN ST
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-3337
Country	:	US
Telephone Number	:	501-315-0059
Fax Number	:	501-315-1320

Provider Business Practice Location Address
First Line	:	722 N MAIN ST
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-3337
Country	:	US
Telephone Number	:	501-315-0059
Fax Number	:	501-315-1320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	05/19/2021

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Directions to “ CLAY B BRASHEARS M.D.” Practice Location

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