MEDICARE: HARRY PHILLIP CLAYBROOK 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	174400000X	Specialist	MD33815	TN
2	208000000X	Pediatrics Physician	MD33815	TN
3	207R00000X	Internal Medicine Physician	MD33815	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	110216162	OTHER	SD	RAILROAD MEDICARE
5	103I119100	OTHER	TN	MEDICARE PTAN BRMC

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
2	3145651	OTHER	TN	BCBS TN PROVIDE #
4	382283	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1801892765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRY PHILLIP CLAYBROOK MD

Provider Business Mailing Address
First Line	:	1021 W OAKLAND AVE STE 310
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-302-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEDICAL PARK BLVD
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-7430
Country	:	US
Telephone Number	:	423-844-1121
Fax Number	:

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	02/27/2024

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Directions to “ HARRY PHILLIP CLAYBROOK MD” Practice Location

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