Provider Demographics
NPI:1578827465
Name:CLAYTON, SANDY KAY (MD)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:KAY
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 MONTGOMERY ST.
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2325
Mailing Address - Country:US
Mailing Address - Phone:563-382-2911
Mailing Address - Fax:563-382-4143
Practice Address - Street 1:901 MONTGOMERY ST.
Practice Address - Street 2:MEDICAL STAFF SERVICES
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2325
Practice Address - Country:US
Practice Address - Phone:563-382-2911
Practice Address - Fax:563-382-4143
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN66067207P00000X
GARTP005630207P00000X
IAMD-44860207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1578827465Medicaid