Healthcare Provider Details

I. General information

NPI: 1255360178
Provider Name (Legal Business Name): KARL RENO CLAYSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6403 COYLE AVENUE
CARMICHAEL CA
95608
US

IV. Provider business mailing address

6403 COYLE AVE 250
CARMICHAEL CA
95608
US

V. Phone/Fax

Practice location:
  • Phone: 916-961-2820
  • Fax: 916-961-2828
Mailing address:
  • Phone: 916-961-2825
  • Fax: 916-961-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG37488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: