Healthcare Provider Details

I. General information

NPI: 1245898279
Provider Name (Legal Business Name): MATTHEW CLAYSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W CARROLL AVE STE 107
GLENDORA CA
91741-4708
US

IV. Provider business mailing address

412 W CARROLL AVE STE 107
GLENDORA CA
91741-4708
US

V. Phone/Fax

Practice location:
  • Phone: 626-914-4890
  • Fax:
Mailing address:
  • Phone: 626-914-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD473
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6197
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: