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General NPI Number Information
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NPI Number | 1083877997
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Entity Type | Organization
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Legal Business Name | MTM&M PLLC
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 4111 WENDELL BLVD
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City | WENDELL
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State | NC
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Zip | 27591-6831
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Country | US
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Telephone | 919-365-8484
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Fax | 919-365-8450
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Provider Business Mailing Address
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Address Line | 4111 WENDELL BLVD
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City | WENDELL
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State | NC
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Zip | 27591-6831
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Country | US
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Telephone | 919-365-8484
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Fax | 919-365-8450
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT E CLAYTON
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Credential | M.D.
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Telephone | 919-261-9727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 30615
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License Number State | NC
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