Healthcare Provider Details

I. General information

NPI: 1912912569
Provider Name (Legal Business Name): CLAYTON BAVOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 HOSPITAL DR SUITE 311
MOUNTAIN VIEW CA
94040
US

IV. Provider business mailing address

2490 HOSPITAL DR SUITE 311
MOUNTAIN VIEW CA
94040-4122
US

V. Phone/Fax

Practice location:
  • Phone: 650-962-4690
  • Fax: 650-962-4694
Mailing address:
  • Phone: 650-962-4690
  • Fax: 650-962-4694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG40530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: