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1629126149

NPI Code Detail

MEDICARE: KELLY M CLAYTON MD

MEDICARE: KELLY M CLAYTON MD

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	MD.29481	AL
2	207P00000X	Emergency Medicine Physician	MD.29481	AL
3	208000000X	Pediatrics Physician	TRN10591	FL
4	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	ME112508	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1629126149	OTHER	AL	TRICARE SOUTH
2	Z01783	OTHER	AL	VIVA HEALTH
3	515-98312	OTHER	AL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	515-98422	OTHER	AL	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629126149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY M CLAYTON MD

Provider Business Mailing Address
First Line	:	1005 JOE DIMAGGIO DR
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 JOE DIMAGGIO DR
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5402
Country	:	US
Telephone Number	:	954-265-3482
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	03/14/2021

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Directions to “ KELLY M CLAYTON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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