MEDICARE: CLAYTON BUBACK 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	2084N0400X	Neurology Physician	35.150170	OH
2	390200000X	Student in an Organized Health Care Education/Training Program

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	:	1598228231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAYTON BUBACK MD

Provider Business Mailing Address
First Line	:	3000 ARLINGTON AVE # MS 1108
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2598
Country	:	US
Telephone Number	:	419-383-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 W CENTRAL AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-3818
Country	:	US
Telephone Number	:	419-291-3900
Fax Number	:

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

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	01/05/2026

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