Healthcare Provider Details

I. General information

NPI: 1417613951
Provider Name (Legal Business Name): CLAYTON K CASEY MD INC A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 OAKDALE RD STE 301
MODESTO CA
95355-3382
US

IV. Provider business mailing address

1501 OAKDALE RD STE 301
MODESTO CA
95355-3382
US

V. Phone/Fax

Practice location:
  • Phone: 209-622-0936
  • Fax: 209-622-0863
Mailing address:
  • Phone: 209-622-0936
  • Fax: 209-622-0863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CLAYTON K CASEY
Title or Position: OWNER/CEO
Credential: MD
Phone: 209-622-0936