MEDICARE: DR. MICHAEL CLIFTON SAYRE 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	207Q00000X	Family Medicine Physician	G24705	CA

General Provider Information

NPI Number	:	1306965660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL CLIFTON SAYRE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7000
Second Line	:	PELICAN BAY STATE PRISON
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-7000
Country	:	US
Telephone Number	:	707-465-9197
Fax Number	:

Provider Business Practice Location Address
First Line	:	5909 LAKE EARL DRIVE
Second Line	:	PELICAN BAY STATE PRISON
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-7000
Country	:	US
Telephone Number	:	707-465-9197
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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