Healthcare Provider Details

I. General information

NPI: 1396716692
Provider Name (Legal Business Name): CATHERINE ANN CLAYTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 THONOTOSASSA RD
PLANT CITY FL
33563-2941
US

IV. Provider business mailing address

2010 THONOTOSASSA RD
PLANT CITY FL
33563-2941
US

V. Phone/Fax

Practice location:
  • Phone: 813-752-0757
  • Fax: 813-752-0753
Mailing address:
  • Phone: 813-752-0752
  • Fax: 813-752-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME49412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: