Healthcare Provider Details

I. General information

NPI: 1083974679
Provider Name (Legal Business Name): CLAYTON AARON CHARLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 01/08/2023
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 STONECHASE LN
LAKE MARY FL
32746-3981
US

IV. Provider business mailing address

205 OSCEOLA ST
LAURIUM MI
49913-2134
US

V. Phone/Fax

Practice location:
  • Phone: 954-224-5121
  • Fax:
Mailing address:
  • Phone: 906-337-6515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPT13876
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2022-02679
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number68383-20
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME126005
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberPT13876
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: