Healthcare Provider Details

I. General information

NPI: 1063413565
Provider Name (Legal Business Name): CLYDE H CLIMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CENTER PARK DRIVE SUITE A
SENECA SC
29678-1152
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-482-2360
  • Fax: 864-482-2365
Mailing address:
  • Phone: 864-797-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number40067
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME39732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: