=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033561832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THYROID CANCER CENTER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2016
-----------------------------------------------------
Last Update Date | 07/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2352 CREEL LN STE 101
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33544-4621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-940-3130
-----------------------------------------------------
Fax | 813-315-6360
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2352 CREEL LN STE 101
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33544-4621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-940-3130
-----------------------------------------------------
Fax | 813-315-6360
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. GARY L CLAYMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 813-940-3130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | ME125739
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------