Healthcare Provider Details

I. General information

NPI: 1609873553
Provider Name (Legal Business Name): LEE STANTON CLORE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 WATHENS CROSSING
OWENSBORO KY
42301-7035
US

IV. Provider business mailing address

3604 WATHENS CROSSING
OWENSBORO KY
42301-7035
US

V. Phone/Fax

Practice location:
  • Phone: 270-684-6144
  • Fax: 270-684-2944
Mailing address:
  • Phone: 270-684-6144
  • Fax: 270-684-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number33785
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: