MEDICARE: ALEXANDER CLAYTON MAST DO

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	208000000X	Pediatrics Physician	5101024607	MI

General Provider Information

NPI Number	:	1679920755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER CLAYTON MAST DO

Provider Business Mailing Address
First Line	:	1140 S KNOXVILLE AVE STE D
Second Line	:
City	:	SAINT MARYS
State	:	OH
Zip	:	45885-2609
Country	:	US
Telephone Number	:	419-300-1129
Fax Number	:	419-394-9575

Provider Business Practice Location Address
First Line	:	1010 HAGER ST
Second Line	:
City	:	SAINT MARYS
State	:	OH
Zip	:	45885-2421
Country	:	US
Telephone Number	:	419-394-9579
Fax Number	:	419-394-9580

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

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	08/02/2023

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