Healthcare Provider Details

I. General information

NPI: 1073521647
Provider Name (Legal Business Name): TONYA MARIA CLAYTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY DEPARTMENT OF PEDIATRICS
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

1501 KINGS HWY DEPARTMENT OF PEDIATRICS
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-7737
  • Fax: 318-675-5666
Mailing address:
  • Phone: 318-675-7737
  • Fax: 318-675-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number023335
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: