MEDICARE: DR. CLAY DUVAL 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	DR.0062991	CO

General Provider Information

NPI Number	:	1386098945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAY DUVAL M.D.

Provider Business Mailing Address
First Line	:	6011 E WOODMEN RD STE 125
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2603
Country	:	US
Telephone Number	:	719-571-8030
Fax Number	:	719-571-8031

Provider Business Practice Location Address
First Line	:	6011 E WOODMEN RD STE 125
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2603
Country	:	US
Telephone Number	:	719-571-8030
Fax Number	:	719-571-8031

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

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	08/26/2019

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