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General NPI Number Information
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NPI Number | 1629126149
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Entity Type | Individual
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Provider Name | KELLY M CLAYTON MD
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 03/14/2021
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Provider Practice Location Address
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Address Line | 1005 JOE DIMAGGIO DR
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5402
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Country | US
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Telephone | 954-265-3482
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 JOE DIMAGGIO DR
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5402
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD.29481
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD.29481
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | TRN10591
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | ME112508
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License Number State | FL
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