Individual
COREY D CLAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
1651 GALISTEO ST STE 8, SANTA FE, NM 87505-4752
(505) 820-9870
(505) 983-1265
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
MD2019-0525
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
76683877
—
NM
01
—
825732
MEDICARE PTAN
NM
01
—
875307
MEDICARE PTAN
NM
Enumeration date
04/08/2011
Last updated
10/30/2023
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