Healthcare Provider Details

I. General information

NPI: 1306891460
Provider Name (Legal Business Name): CONRAD ALLISON CLAYTOR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 BRAEBURN DR
SALEM VA
24153-7302
US

IV. Provider business mailing address

1934 BRAEBURN DR
SALEM VA
24153-7302
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-0253
  • Fax: 540-982-1996
Mailing address:
  • Phone: 540-982-0253
  • Fax: 540-982-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103000782
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: