MR. CLAYTON PHILLIP GATTERDAM IV


Address: 3205 Summit Square Suite 100, Lexington, KY 40509
Phone: 8593359041

MR. CLAYTON PHILLIP GATTERDAM IV (NPI# 1174890172) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1174890172
Entity Type Individual
Full Name MR. CLAYTON PHILLIP GATTERDAM IV
Credential PA-C
Practice Address 3205 Summit Square Suite 100
Lexington
KY 40509
Practice Telephone 8593359041
Mailing Telephone 8593359041
Enumeration Date 2011-11-19
Last Update Date 2011-11-19
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AM0700X Physician Assistant
Specialization: Medical
TC065 KY Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 3205 SUMMIT SQUARE SUITE 100
City LEXINGTON
State KY
Zip Code 40509

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1699273599 Frederick Douglas High School Public Health or Welfare 2000 Winchester Rd, Lexington, KY 40509 2018-01-25
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Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1306118617 Lb Health Psc Physician Assistant 1904 Nicholasville Rd, Lexington, KY 40503-2025 2012-02-01
1134237340 Rebecca Ward Hogsten Physician Assistant 4071 Tates Creek Centre Dr Ste 100, Lexington, KY 40517-3062 2006-08-28
1427003524 David Wendell Moore Physician Assistant 101 Prosperous Pl Ste 300, Lexington, KY 40509-1836 2006-05-24
1376514760 Kerri F Stillwell Physician Assistant 110 Houston Street, Lexington, VA 24450-0912 2006-02-01
1215914684 Philip Harold Lafleur Physician Assistant 1055 Dove Run Road, Lexington, KY 40502 2005-12-28
1083690317 Jana Sue Cuddy Physician Assistant 1055 Dove Run Rd, Lexington, KY 40502 2005-12-19
1942852157 Anna Gayle Scott Physician Assistant 989 Governors Ln Ste 220, Lexington, KY 40513-1175 2019-07-09
1609333582 Hannah Leigh Burford Physician Assistant 1401 Harrodsburg Rd Ste C305, Lexington, KY 40504-3771 2019-02-27
1881177186 Sarah Kruyer Physician Assistant 250 Hospital Dr, Lexington, NC 27292-6792 2018-09-12
1376073106 Megan Eileen Smith Physician Assistant 250 Hospital Dr, Lexington, NC 27292-6792 2017-06-14
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Competitor

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City LEXINGTON
Zip Code 40509

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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