Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1154944866 |
---|---|
Provider Name | Clayton Travis Prescott |
First Address | Flint, MI 48507-1123 |
Second Address | Flint, MI 48507-1123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2020 |
Last Update Date | 28/05/2020 |