Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 003475 | MO |
NPI | 1073674958 |
---|---|
Provider Name | Dr. Clyde Edward Foland |
First Address | Hazelwood, MO 63042-1170 |
Second Address | Hazelwood, MO 63042-1170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1038020 | CIGNA (01) | MO |
277821 | UNITED HEALTHCARE (01) | MO |
6392 | BLUE CROSS & BLUE SHIELD (01) | MO |
645703 | AM CHIRO NET (01) | MO |
CF1038020 | ASHLINK (01) | MO |
T43165 | (02) | MO |