Healthcare Provider Details

I. General information

NPI: 1144366428
Provider Name (Legal Business Name): LLOYD J. CLEAVER, D.O., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/29/2016
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: 660-956-7096
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: LLOYD JEROME CLEAVER
Title or Position: OWNER
Credential: D.O.
Phone: 660-627-7546