Provider Demographics
NPI:1093825424
Name:CLEGG, CYNTHIA O (MD)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:O
Last Name:CLEGG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 E HIGHWAY ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5132
Mailing Address - Country:US
Mailing Address - Phone:830-997-0898
Mailing Address - Fax:830-997-6016
Practice Address - Street 1:95 E HIGHWAY ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5132
Practice Address - Country:US
Practice Address - Phone:830-997-0898
Practice Address - Fax:830-997-6016
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5274207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH50856Medicare UPIN
TX8387M1Medicare ID - Type UnspecifiedMEDICARE