Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD60763576 | WA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35134940 | OH |
NPI | 1548528573 |
---|---|
Provider Name | Clayton Alan Carmody |
First Address | Sylvania, OH 43560-9263 |
Second Address | Sylvania, OH 43560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2012 |
Last Update Date | 06/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0313996 | (05) | OH |
H648600 | MEDICARE (01) | OH |
H648601 | MEDICARE (01) | OH |