Provider Demographics
NPI:1174554729
Name:REINHARDT, CLAYTON GEORGE (DO)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:GEORGE
Last Name:REINHARDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 E CREEKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-9869
Mailing Address - Country:US
Mailing Address - Phone:530-945-7189
Mailing Address - Fax:541-904-0685
Practice Address - Street 1:956 E CREEKSIDE CT
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-9869
Practice Address - Country:US
Practice Address - Phone:530-945-7189
Practice Address - Fax:541-904-0685
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 6323208D00000X
ORDO176952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F65214Medicare UPIN