Provider Demographics
NPI:1124204284
Name:CLAY, DENNIS B (CRNA)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:B
Last Name:CLAY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 MEDICAL PKWY STE 570
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1024
Mailing Address - Country:US
Mailing Address - Phone:512-454-2554
Mailing Address - Fax:512-454-1532
Practice Address - Street 1:3705 MEDICAL PKWY STE 570
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1024
Practice Address - Country:US
Practice Address - Phone:512-454-2554
Practice Address - Fax:512-454-1532
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1115760367500000X
TX114274367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered