Provider Demographics
NPI:1679572473
Name:KLINEFELTER, VERNON RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:RAY
Last Name:KLINEFELTER
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 1:1141 N CHENEY ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-2741
Mailing Address - Country:US
Mailing Address - Phone:217-824-2524
Mailing Address - Fax:217-824-2588
Practice Address - Street 1:1141 N CHENEY ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-2741
Practice Address - Country:US
Practice Address - Phone:217-824-2524
Practice Address - Fax:217-824-2588
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2024-05-04
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD93942Medicare UPIN
ILL88120Medicare ID - Type Unspecified