Provider Demographics
NPI:1437356912
Name:MCCLOUD, COREY LEE
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:LEE
Last Name:MCCLOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-2055 KAIOLI ST APT 3902
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6151
Mailing Address - Country:US
Mailing Address - Phone:760-500-4000
Mailing Address - Fax:
Practice Address - Street 1:NAVY HEALTH CLINIC HAWAII
Practice Address - Street 2:MAKALAPA FAMILY PRATICE CLINIC
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:760-500-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman