1780976266 NPI number — CLAYTON MICHAEL MARAIST M.D.

Table of content: CLAYTON MICHAEL MARAIST M.D. (NPI 1780976266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780976266 NPI number — CLAYTON MICHAEL MARAIST M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARAIST
Provider First Name:
CLAYTON
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780976266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12137
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW IBERIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70562-2137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-256-8779
Provider Business Mailing Address Fax Number:
337-359-4997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2309 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NEW IBERIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70560-4046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-256-8779
Provider Business Practice Location Address Fax Number:
337-359-4997
Provider Enumeration Date:
05/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD.207826 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2144235 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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