Provider Demographics
NPI:1063498533
Name:CLEMENTS, LLOYD SCOTT (MD PHD)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:SCOTT
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:1504 SPRINGHILL AVE
Practice Address - Street 2:SUITE 1600
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3207
Practice Address - Country:US
Practice Address - Phone:251-434-3915
Practice Address - Fax:251-434-3802
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023115208000000X
AL23115208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00709300Medicaid
FL276517900Medicaid
AL51536493OtherBCBS
LA1583669Medicaid
AL009938906Medicaid