Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 39775 | CA |
NPI | 1003995150 |
---|---|
Provider Name | Mr. Jeffrey R Clayton |
First Address | San Leandro, CA 94577 |
Second Address | San Leandro, CA 94577 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |