Provider Demographics
NPI:1851447890
Name:CLAVO, ANTHONY T SR (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:T
Last Name:CLAVO
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 801475
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380
Mailing Address - Country:US
Mailing Address - Phone:404-354-0153
Mailing Address - Fax:770-632-3731
Practice Address - Street 1:10400 N. CENTRAL EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-972-2427
Practice Address - Fax:415-795-4434
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8962207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG72848OtherMEDICARE UPIN