Healthcare Provider Details

I. General information

NPI: 1497986202
Provider Name (Legal Business Name): LACEY DAWN CLAWSON D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 REGIONAL PLZ STE 1016
ABILENE TX
79606-5223
US

IV. Provider business mailing address

2074 ANTILLEY RD
ABILENE TX
79606-5209
US

V. Phone/Fax

Practice location:
  • Phone: 325-793-5135
  • Fax: 325-793-5136
Mailing address:
  • Phone: 325-698-3865
  • Fax: 257-931-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: