Healthcare Provider Details

I. General information

NPI: 1811981012
Provider Name (Legal Business Name): CLAYTON A FRANCIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

210 4TH AVE
GRINNELL IA
50112-0780
US

IV. Provider business mailing address

P O BOX 780 210 4TH AVE
GRINNELL IA
50112-0780
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-2500
  • Fax: 641-236-2539
Mailing address:
  • Phone: 641-236-2500
  • Fax: 641-236-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30077
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: