MEDICARE: PAUL MICHAEL CLAIBORNE MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	R2307	TX

General Provider Information

NPI Number	:	1205192994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL MICHAEL CLAIBORNE MD

Provider Business Mailing Address
First Line	:	6600 FISH POND RD STE 101
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-2582
Country	:	US
Telephone Number	:	254-776-3188
Fax Number	:	254-776-3607

Provider Business Practice Location Address
First Line	:	6600 FISH POND RD STE 101
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-2582
Country	:	US
Telephone Number	:	254-776-3188
Fax Number	:	254-776-3607

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

Provider Enumeration Date	:	04/06/2012
Last Update Date	:	07/21/2022

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