Provider Demographics
NPI:1609967447
Name:CLAYTON, MICHAEL DEWIT (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEWIT
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3599 SUELDO ST
Mailing Address - Street 2:110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7329
Mailing Address - Country:US
Mailing Address - Phone:805-786-2500
Mailing Address - Fax:805-781-0423
Practice Address - Street 1:77 CASA ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5803
Practice Address - Country:US
Practice Address - Phone:805-786-2500
Practice Address - Fax:805-781-0423
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA45346208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A453460Medicaid
CAE97882Medicare UPIN
CA00A453460Medicaid
CAWA45346DMedicare PIN
CAWA45346AMedicare PIN