Healthcare Provider Details

I. General information

NPI: 1710205265
Provider Name (Legal Business Name): CLAY MADISON ELSWICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W MAYFIELD RD STE 407
ARLINGTON TX
76014-2085
US

IV. Provider business mailing address

515 W MAYFIELD RD STE 407
ARLINGTON TX
76014-2085
US

V. Phone/Fax

Practice location:
  • Phone: 682-219-0357
  • Fax: 817-419-2943
Mailing address:
  • Phone: 682-219-0357
  • Fax: 817-419-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number4301110683
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: