Provider Demographics
NPI:1083791875
Name:CLENDENIN, WILLIAM WRIGHT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WRIGHT
Last Name:CLENDENIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7428 ETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1608
Mailing Address - Country:US
Mailing Address - Phone:314-567-0560
Mailing Address - Fax:314-989-1336
Practice Address - Street 1:7428 ETHEL AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1608
Practice Address - Country:US
Practice Address - Phone:314-567-0560
Practice Address - Fax:314-989-1336
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR38192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21842OtherBLUE SHIELD
MOA11781Medicare UPIN