MEDICARE: DR. CLAUDE ROBERT CLONINGER 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	2084P0800X	Psychiatry Physician	32703	MO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457379877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAUDE ROBERT CLONINGER MD

Provider Business Mailing Address
First Line	:	660 S EUCLID AVE
Second Line	:	C B 8134
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1010
Country	:	US
Telephone Number	:	314-286-1700
Fax Number	:	314-286-1799

Provider Business Practice Location Address
First Line	:	4940 CHILDRENS PL RM 3308
Second Line	:	ROOM 3308
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1000
Country	:	US
Telephone Number	:	314-286-1700
Fax Number	:	314-286-1799

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	01/24/2018

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