Provider Demographics
NPI:1336142348
Name:CLEMENT, DONALD J (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:CLEMENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17501 E 40 HWY
Mailing Address - Street 2:STE 213A
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6445
Mailing Address - Country:US
Mailing Address - Phone:816-478-4887
Mailing Address - Fax:816-478-7222
Practice Address - Street 1:5330 N OAK TRFY
Practice Address - Street 2:#102
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4699
Practice Address - Country:US
Practice Address - Phone:816-478-4887
Practice Address - Fax:816-478-7222
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207738709Medicaid
MO100006171Medicare PIN
MOF90080Medicare UPIN
MO4189535AMedicare PIN