MEDICARE: DR. VALERIE J CLEGG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35.073201	OH

General Provider Information

NPI Number	:	1346223237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VALERIE J CLEGG MD

Provider Business Mailing Address
First Line	:	1311 N POINT LN
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72118-2367
Country	:	US
Telephone Number	:	501-771-0739
Fax Number	:

Provider Business Practice Location Address
First Line	:	1090 ARNOLD DR
Second Line	:	314TH MEDICAL GROUP
City	:	LITTLE ROCK AFB
State	:	AR
Zip	:	72099-4933
Country	:	US
Telephone Number	:	501-987-8911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	07/08/2007

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