Healthcare Provider Details

I. General information

NPI: 1609950831
Provider Name (Legal Business Name): CLAYTON D LANPHEAR III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 MAIN ST
CHEPACHET RI
02814
US

IV. Provider business mailing address

1133 MAIN ST PO BOX Q
CHEPACHET RI
02814
US

V. Phone/Fax

Practice location:
  • Phone: 401-568-6658
  • Fax:
Mailing address:
  • Phone: 401-568-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO272
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: