Healthcare Provider Details

I. General information

NPI: 1700503554
Provider Name (Legal Business Name): CLAYTON ANDERSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 HARCOURT RD STE 125
INDIANAPOLIS IN
46260-2094
US

IV. Provider business mailing address

8450 NORTHWEST BLVD
INDIANAPOLIS IN
46278-1381
US

V. Phone/Fax

Practice location:
  • Phone: 317-802-2000
  • Fax: 317-802-2050
Mailing address:
  • Phone: 317-802-2000
  • Fax: 317-802-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003979A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: