Provider Demographics
NPI:1104829829
Name:CLEAVER, LLOYD J (DO)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:J
Last Name:CLEAVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-5362
Mailing Address - Country:US
Mailing Address - Phone:660-627-7546
Mailing Address - Fax:660-956-7097
Practice Address - Street 1:1316 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-5362
Practice Address - Country:US
Practice Address - Phone:660-627-7546
Practice Address - Fax:660-956-7097
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8895207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODG4290OtherRAILROAD MEDICARE GROUP#
MO070004124OtherRAILROAD MEDICARE
000014853OtherMEDICARE GROUP #
MO501218200OtherMEDICAID GROUP#
MO242210912Medicaid
MODG4290OtherRAILROAD MEDICARE GROUP#
MO501218200OtherMEDICAID GROUP#