Provider Demographics
NPI:1932216231
Name:CLAYBROOK, DOUGLAS E (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:CLAYBROOK
Suffix:
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3130
Mailing Address - Fax:812-242-3596
Practice Address - Street 1:221 S 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-4214
Practice Address - Country:US
Practice Address - Phone:812-242-3130
Practice Address - Fax:812-242-3596
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029167A208800000X
IL36089198208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100250650Medicaid
000000089642OtherANTHEM
340009236OtherRAILROAD MCARE PALAMETTO
340009242OtherRAILROAD MCARE PALAMETTO
INP00828496OtherRAILROAD MEDICARE
IN100250650UMedicaid
IN859910EMedicare PIN
340009236OtherRAILROAD MCARE PALAMETTO
IN100250650Medicaid
000000089642OtherANTHEM
INP00828496OtherRAILROAD MEDICARE