Individual
CLAY O. DEMATTEI I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3402 OFFICE PARK DR., MARION, IL 62959
(618) 993-3221
Mailing address
3402 OFFICE PARK DR., MARION, IL 62959
(618) 993-3221
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036072552
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036072552
STATE LICENSE NUMBER
IL
05
—
036072552
—
IL
Enumeration date
06/26/2006
Last updated
01/05/2021
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