Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 0101260422 | VA |
N | 207RC0200X | Critical Care Medicine | 39931 | NC |
N | 207RP1001X | Pulmonary Disease | 0101260422 | VA |
Y | 207RP1001X | Pulmonary Disease | 39931 | NC |
N | 207RS0012X | Sleep Medicine | 39931 | NC |
NPI | 1013983345 |
---|---|
Provider Name | Lois Gail Clary |
First Address | Salt Lake City, UT 84127-0877 |
Second Address | Hendersonville, NC 28739-4164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 21/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22792 | BCBS NC PROVIDER # (01) | NC |
290008578 | RR MEDICARE (01) | |
8922792 | (05) | NC |
C73170 | (02) | |
P01272362 | RR MEDICARE (01) | NC |