Basic Information
| Provider Information | |||||||||
| NPI: | 1619968021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAYSON | ||||||||
| FirstName: | DARBY | ||||||||
| MiddleName: | ANNETTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 SULLIVAN AVE | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156804135 | ||||||||
| FaxNumber: | 7024535741 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 SULLIVAN AVE | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156804135 | ||||||||
| FaxNumber: | 7024535741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 12/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | 11502 | NV | N | Other Service Providers | Military Health Care Provider | 207R00000X | 11502 | NV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A139455 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.