Healthcare Provider Details

I. General information

NPI: 1245344563
Provider Name (Legal Business Name): HENRY TUCKER CLAY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 2ND ST SE
CUT BANK MT
59427-3329
US

IV. Provider business mailing address

802 2ND ST SE
CUT BANK MT
59427-3329
US

V. Phone/Fax

Practice location:
  • Phone: 406-873-2251
  • Fax: 406-873-3118
Mailing address:
  • Phone: 406-873-2251
  • Fax: 406-873-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number54182
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19715
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: