Provider Demographics
NPI:1174778450
Name:CLAYTON, MATTHEW JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1675 N FREEDOM BLVD
Mailing Address - Street 2:STE 9C
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2540
Mailing Address - Country:US
Mailing Address - Phone:801-377-4800
Mailing Address - Fax:801-377-4041
Practice Address - Street 1:1675 N FREEDOM BLVD
Practice Address - Street 2:STE 9C
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2540
Practice Address - Country:US
Practice Address - Phone:801-377-4800
Practice Address - Fax:801-377-4041
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-30
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT7083789-1204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics