Individual
MR. CLAYTON PHILLIP GATTERDAM IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
700 BOB O LINK DR, LEXINGTON, KY 40504-3756
(859) 258-8575
(859) 258-8562
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-6200
(859) 258-6203
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1689
KY
363AM0700X
Medical Physician Assistant
PA1689
KY
363AS0400X
Surgical Physician Assistant
PA1689
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100223020
—
KY
Enumeration date
11/19/2011
Last updated
10/16/2023
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