MEDICARE: DR. CLAYTON THOMAS NADDELL 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	207R00000X	Internal Medicine Physician	A156330	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1699126904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAYTON THOMAS NADDELL MD

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	11600 INDIAN HILLS RD STE 102
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-1225
Country	:	US
Telephone Number	:	818-838-4500
Fax Number	:

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

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	03/09/2026

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