Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 12506876 | IL |
N | 208600000X | Surgeon | 12506876 | IL |
Y | 208200000X | Surgeon | 2019014000 | MO |
Y | 208600000X | Surgeon | 2019014000 | MO |
NPI | 1013322080 |
---|---|
Provider Name | Dr. Clayton Lewis Theleman |
First Address | Kansas City, MO 64121-9672 |
Second Address | Liberty, MO 64068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2014 |
Last Update Date | 27/06/2019 |