Provider Demographics
NPI:1174122253
Name:ISENBERG, CLAYTON HOYT
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:HOYT
Last Name:ISENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 HIGHWAY 5 N
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9028
Mailing Address - Country:US
Mailing Address - Phone:501-847-2880
Mailing Address - Fax:501-847-2881
Practice Address - Street 1:1122 TAHOE DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-5009
Practice Address - Country:US
Practice Address - Phone:501-847-2880
Practice Address - Fax:501-847-2881
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR196323407Medicaid