Provider Demographics
NPI:1619955549
Name:CLONTS, EDWIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:L
Last Name:CLONTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 502878
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-2878
Mailing Address - Country:US
Mailing Address - Phone:670-234-2901
Mailing Address - Fax:670-234-2906
Practice Address - Street 1:KULOT DI ROSA DR. CHALAN KIYA
Practice Address - Street 2:HEALTH PROFESSIONAL CORPORATION
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-2878
Practice Address - Country:US
Practice Address - Phone:670-234-2901
Practice Address - Fax:670-234-2906
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23309207Q00000X
MP0522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine