Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 2010003182 | MO |
NPI | 1033431903 |
---|---|
Provider Name | Jonathan Lloyd Cleaver |
First Address | Kirksville, MO 63501-5362 |
Second Address | Kirksville, MO 63501-5362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2010 |
Last Update Date | 08/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033431903 | (05) | MO |