MEDICARE: TONYA MARIA CLAYTON 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
1	2080P0201X	Pediatric Allergy/Immunology Physician	023335	LA

General Provider Information

NPI Number	:	1073521647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA MARIA CLAYTON M.D.

Provider Business Mailing Address
First Line	:	1501 KINGS HWY
Second Line	:	DEPARTMENT OF PEDIATRICS
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4228
Country	:	US
Telephone Number	:	318-675-7737
Fax Number	:	318-675-5666

Provider Business Practice Location Address
First Line	:	1501 KINGS HWY
Second Line	:	DEPARTMENT OF PEDIATRICS
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4228
Country	:	US
Telephone Number	:	318-675-7737
Fax Number	:	318-675-5666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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