Provider Demographics
NPI:1215189071
Name:CLYDE T. ARNOLD MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CLYDE T. ARNOLD MD A PROFESSIONAL CORPORATION
Other - Org Name:CLYDE T. ARNOLD M.D., INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:T
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-737-2576
Mailing Address - Street 1:8473 S VAN NESS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-1550
Mailing Address - Country:US
Mailing Address - Phone:323-737-2576
Mailing Address - Fax:313-649-5073
Practice Address - Street 1:8473 S VAN NESS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-1550
Practice Address - Country:US
Practice Address - Phone:323-737-2576
Practice Address - Fax:313-649-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22479208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty