Individual
DR. CLAYTON BERT ALEXANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
125 EAST SHORE PARKWAY, SUITE D, LA PORTE, IN 46350
(219) 325-0155
(219) 324-5291
Mailing address
125 EAST SHORE PARKWAY, SUITE D, LA PORTE, IN 46350-5677
(219) 325-0155
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001107A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084179
BLUE CROSS BLUE SHIELD
IN
01
—
080025306
MEDICARE RAILROAD
IN
01
—
15D0355679
CLIA
IN
05
—
300016527
—
IN
Enumeration date
10/14/2005
Last updated
12/08/2020
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