Healthcare Provider Details

I. General information

NPI: 1962538462
Provider Name (Legal Business Name): ALLEN O CLYDE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 MEDICAL CENTER DR E SUITE 106
CLOVIS CA
93611-6807
US

IV. Provider business mailing address

688 MEDICAL CENTER DR E SUITE 106
CLOVIS CA
93611-6807
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-8604
  • Fax: 559-297-0625
Mailing address:
  • Phone: 559-297-8604
  • Fax: 559-297-0625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: