Individual
CLAYTON SOUTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19550 E 39TH ST S STE 300, INDEPENDENCE, MO 64057-2306
(816) 478-0220
Mailing address
19550 E 39TH ST S STE 300, INDEPENDENCE, MO 64057-2306
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2023018869
MO
207V00000X
Obstetrics & Gynecology Physician
LL82658
SC
Other
Enumeration date
06/03/2019
Last updated
11/28/2023
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