Provider Demographics
NPI:1588969711
Name:ROYDER, CLAYTON HOWARD (DO)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:HOWARD
Last Name:ROYDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5252 N MERIDIAN AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2178
Mailing Address - Country:US
Mailing Address - Phone:405-601-3330
Mailing Address - Fax:405-601-3392
Practice Address - Street 1:5252 N MERIDIAN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2178
Practice Address - Country:US
Practice Address - Phone:405-601-3330
Practice Address - Fax:405-601-3392
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200413360AMedicaid