Healthcare Provider Details

I. General information

NPI: 1235448192
Provider Name (Legal Business Name): MICHAEL H CLAYTON, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 VIRGINIA ST NE SUITE A
ALBUQUERQUE NM
87110-4694
US

IV. Provider business mailing address

2509 VIRGINIA ST NE SUITE A
ALBUQUERQUE NM
87110-4694
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-5426
  • Fax: 505-296-1248
Mailing address:
  • Phone: 505-296-5426
  • Fax: 505-296-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberNM8919
License Number StateNM

VIII. Authorized Official

Name: DR. MICHAEL HENSLEY CLAYTON
Title or Position: PRESIDENT, CORPORATION
Credential: M.D.
Phone: 505-296-5426