Healthcare Provider Details

I. General information

NPI: 1104829829
Provider Name (Legal Business Name): LLOYD J CLEAVER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 COUNTRY CLUB DR
KIRKSVILLE MO
63501-5362
US

IV. Provider business mailing address

1316 COUNTRY CLUB DR
KIRKSVILLE MO
63501-5362
US

V. Phone/Fax

Practice location:
  • Phone: 660-627-7546
  • Fax: 660-956-7097
Mailing address:
  • Phone: 660-627-7546
  • Fax: 660-956-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberR8895
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: