Healthcare Provider Details

I. General information

NPI: 1497487698
Provider Name (Legal Business Name): NATHAN ROBERT CLYDE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BELLEMEADE AVE STE 110
EVANSVILLE IN
47714-0111
US

IV. Provider business mailing address

7366 ACORN DR
NEWBURGH IN
47630-2976
US

V. Phone/Fax

Practice location:
  • Phone: 435-757-2015
  • Fax:
Mailing address:
  • Phone: 435-757-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD.0000964
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number41000458A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: