Healthcare Provider Details

I. General information

NPI: 1942555081
Provider Name (Legal Business Name): CLAY MICHAEL PENDLETON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2012
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ANGLERS DR SUITE 202
STEAMBOAT SPRINGS CO
80487-8840
US

IV. Provider business mailing address

501 ANGLERS DR STE 202
STEAMBOAT SPRINGS CO
80487-8841
US

V. Phone/Fax

Practice location:
  • Phone: 970-871-9710
  • Fax: 970-871-9709
Mailing address:
  • Phone: 970-871-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0053605
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0053605
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: