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NPI Code Detail

MEDICARE: DR. JESSE E CLANTON M.D.

MEDICARE: DR. JESSE E CLANTON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianC5274AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033106505
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSE E CLANTON M.D.
Provider Business Mailing Address
First Line : 2302 COLLEGE AVE
Second Line :
City : CONWAY
State : AR
Zip : 72034-6297
Country : US
Telephone Number : 501-513-5793
Fax Number : 501-513-5417
Provider Business Practice Location Address
First Line : 2302 COLLEGE AVE
Second Line :
City : CONWAY
State : AR
Zip : 72034-6297
Country : US
Telephone Number : 501-513-5793
Fax Number : 501-513-5417
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2005
Last Update Date : 07/29/2010

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