Basic Information
| Provider Information | |||||||||
| NPI: | 1740240407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMON | ||||||||
| FirstName: | CLAYTON | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 TIERRA GRANDE | ||||||||
| Address2: | |||||||||
| City: | CIBOLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781084241 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8901 ROCKVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208890001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012954000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZB0001X | 045124 | GA | Y | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine |
No ID Information.