Healthcare Provider Details

I. General information

NPI: 1184767642
Provider Name (Legal Business Name): DR. CLAYTON LEE MYERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 N FEDERAL HWY
FT LAUDERDALE FL
33306-1424
US

IV. Provider business mailing address

2780 N FEDERAL HWY
FT LAUDERDALE FL
33306-1424
US

V. Phone/Fax

Practice location:
  • Phone: 954-564-1111
  • Fax: 954-564-0126
Mailing address:
  • Phone: 954-564-1111
  • Fax: 954-564-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberME30938
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: