Provider Demographics
NPI:1073938577
Name:MOORE, CLAYTON (DO, PHARMD, PA-C)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:
Last Name:MOORE
Suffix:
Gender:
Credentials:DO, PHARMD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-2011
Mailing Address - Country:US
Mailing Address - Phone:252-641-7700
Mailing Address - Fax:
Practice Address - Street 1:4800 S CROATAN HWY
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-9704
Practice Address - Country:US
Practice Address - Phone:252-449-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07792207P00000X, 363AM0700X
NC22426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-07792OtherNC PA LICENSE NUMBER
NC222426OtherNC STATE LICENSE NUMBER- PHARMACY