Healthcare Provider Details

I. General information

NPI: 1912001165
Provider Name (Legal Business Name): FRED E CLAYSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD #3600
OGDEN UT
84403-3285
US

IV. Provider business mailing address

4403 HARRISON BLVD #3600
OGDEN UT
84403-3285
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-3550
  • Fax: 801-387-3555
Mailing address:
  • Phone: 801-387-3550
  • Fax: 801-387-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1566231205
License Number StateUT

VIII. Authorized Official

Name: FRED E CLAYSON
Title or Position: PHYSICIAN
Credential: MD
Phone: 801-387-3550