MEDICARE: NEIL C CLEMENTS JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	17696	AZ
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	17696	AZ
3	207RP1001X	Pulmonary Disease Physician	17696	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013909365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL C CLEMENTS JR. MD

Provider Business Mailing Address
First Line	:	9420 E GOLF LINK ROAD, STE 108
Second Line	:	PMB 284
City	:	TUCSON
State	:	AZ
Zip	:	85730
Country	:	US
Telephone Number	:	520-447-7413
Fax Number	:	520-210-7422

Provider Business Practice Location Address
First Line	:	9420 E GOLF LINK ROAD, STE 108
Second Line	:	PMB 284
City	:	TUCSON
State	:	AZ
Zip	:	85730
Country	:	US
Telephone Number	:	520-447-7413
Fax Number	:	520-210-7422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/03/2023

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