MEDICARE: DR. ERIC RICHARD CLAUSSEN DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN17080	FL
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	DN17080	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1194983965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC RICHARD CLAUSSEN DMD

Provider Business Mailing Address
First Line	:	2624 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4311
Country	:	US
Telephone Number	:	850-215-0798
Fax Number	:

Provider Business Practice Location Address
First Line	:	2624 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4311
Country	:	US
Telephone Number	:	850-215-0798
Fax Number	:

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

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	08/05/2015

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