Healthcare Provider Details

I. General information

NPI: 1740522937
Provider Name (Legal Business Name): CLAY WILLIAM YAKLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 11/30/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2644
  • Fax: 314-454-2110
Mailing address:
  • Phone: 214-456-7000
  • Fax: 214-456-8132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberS6984
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2016011924
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: