Healthcare Provider Details

I. General information

NPI: 1558949826
Provider Name (Legal Business Name): KYLE JAMES CLAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

1111 6TH AVE
DES MOINES IA
50314-2613
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-2261
  • Fax: 515-643-5802
Mailing address:
  • Phone: 515-643-2261
  • Fax: 515-643-5802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT-4459
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-52994
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: