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General NPI Number Information
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NPI Number | 1992899645
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Entity Type | Individual
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Provider Name | ANGELA COLEEN MOORE CLAY D.O.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 1059 BARTON DR
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City | FORDLAND
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State | MO
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Zip | 65652-7350
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Country | US
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Telephone | 417-767-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 100 HOSPITAL DR
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City | LEBANON
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State | MO
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Zip | 65536-9210
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Country | US
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Telephone | 417-533-6350
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Fax | 417-533-6350
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MO2001026670
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2001026670
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | MO2001026670
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License Number State | MO
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