Healthcare Provider Details

I. General information

NPI: 1073938577
Provider Name (Legal Business Name): CLAYTON MOORE DO, PHARM.D, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1929
US

IV. Provider business mailing address

500 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1929
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-2000
  • Fax:
Mailing address:
  • Phone: 757-594-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-07792
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22426
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0010-07792
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: