Provider Demographics
NPI:1154438620
Name:CLAYTON, GARY R (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 8235
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-0235
Mailing Address - Country:US
Mailing Address - Phone:409-839-4757
Mailing Address - Fax:409-839-4294
Practice Address - Street 1:740 HOSPITAL DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4664
Practice Address - Country:US
Practice Address - Phone:409-839-4757
Practice Address - Fax:409-839-4294
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH5430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128406906Medicaid
TX173193701Medicaid
TXE12316Medicare UPIN
TX173193701Medicaid