Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | ME49412 | FL |
NPI | 1396716692 |
---|---|
Provider Name | Dr. Catherine Ann Clayton |
First Address | Plant City, FL 33563-2941 |
Second Address | Plant City, FL 33563-2941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 02/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
263636100 | (05) | FL |
B48759 | (02) | FL |