Healthcare Provider Details

I. General information

NPI: 1477486215
Provider Name (Legal Business Name): CLAYTON SALMON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 E 397 N
RIGBY ID
83442-5456
US

IV. Provider business mailing address

3750 TAYLORVIEW LN
AMMON ID
83406-7523
US

V. Phone/Fax

Practice location:
  • Phone: 208-448-7429
  • Fax:
Mailing address:
  • Phone: 208-757-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberI71136
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: