Individual
MARY SHANNON CLAYTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3920 DUTCHMANS LN, LOUISVILLE, KY 40207-4702
(502) 259-6710
(502) 259-6704
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01076935A
IN
207L00000X
Anesthesiology Physician
Primary
57339
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201374870
—
IN
05
—
7100247940
—
KY
Enumeration date
03/27/2012
Last updated
03/22/2023
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