Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 3871 | OK |
Y | 213EG0000X | General Practice | 3871 | OK |
NPI | 1003002916 |
---|---|
Provider Name | Dr. James Bernerd Clevering |
First Address | Lawton, OK 73501-3710 |
Second Address | Lawton, OK 73501-3710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2007 |
Last Update Date | 25/09/2007 |