Healthcare Provider Details

I. General information

NPI: 1427598911
Provider Name (Legal Business Name): CLAYTON FARAHANI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/29/2023
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SANTA ROSA
SAN ANTONIO TX
78207-3108
US

IV. Provider business mailing address

10228 E 115TH ST S
BIXBY OK
74008-3210
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberT5884
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: