MEDICARE: DR. DALE EDWARD CLOYD M.D.

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	171000000X	Military Health Care Provider	17246	WA

General Provider Information

NPI Number	:	1316937592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE EDWARD CLOYD M.D.

Provider Business Mailing Address
First Line	:	310 S FAYETTE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-5903
Country	:	US
Telephone Number	:	202-782-6765
Fax Number	:	202-782-4416

Provider Business Practice Location Address
First Line	:	WALTER REED ARMY MEDICAL CENTER
Second Line	:	6900 GEORGIA AVE
City	:	WASHINGTON
State	:	DC
Zip	:	20307-0001
Country	:	US
Telephone Number	:	202-782-6765
Fax Number	:	202-782-4416

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/08/2007

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