Provider Demographics
NPI:1710231394
Name:MCCLOUD, DEBORAH JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:JANE
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2794 N LOMA LINDA DR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:MO
Mailing Address - Zip Code:64804-8863
Mailing Address - Country:US
Mailing Address - Phone:417-782-4672
Mailing Address - Fax:417-782-1329
Practice Address - Street 1:2794 N LOMA LINDA DR
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:MO
Practice Address - Zip Code:64804-8863
Practice Address - Country:US
Practice Address - Phone:417-782-4672
Practice Address - Fax:417-782-1329
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104251207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOBO5916Medicare UPIN