Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD.36792 | AL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 36792 | AL |
NPI | 1215376041 |
---|---|
Provider Name | Terry Bradly Clay |
First Address | Mobile, AL 36640-0480 |
Second Address | Mobile, AL 36604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2013 |
Last Update Date | 24/05/2019 |