Provider Demographics
NPI:1417949785
Name:CLOW, DELOS J (DO)
Entity Type:Individual
Prefix:DR
First Name:DELOS
Middle Name:J
Last Name:CLOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2791 N WASHINGTON ST
Mailing Address - Street 2:HEDRICK OB/GYN ASSOCIATES
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-2902
Mailing Address - Country:US
Mailing Address - Phone:660-646-2682
Mailing Address - Fax:660-214-8647
Practice Address - Street 1:2791 N WASHINGTON ST
Practice Address - Street 2:HEDRICK OB/GYN ASSOCIATES
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-2902
Practice Address - Country:US
Practice Address - Phone:660-646-2682
Practice Address - Fax:660-214-8647
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004035412207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207175902Medicaid
MOL48D653Medicare ID - Type Unspecified
MOA17670Medicare UPIN