Healthcare Provider Details

I. General information

NPI: 1083610505
Provider Name (Legal Business Name): SCOTT C CLAYCOMB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HIGHWAY 425 S
MONTICELLO AR
71655-4611
US

IV. Provider business mailing address

301 HIGHWAY 425 S
MONTICELLO AR
71655-4611
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-8534
  • Fax: 870-367-0264
Mailing address:
  • Phone: 870-367-8534
  • Fax: 870-367-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC7907
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: