Provider Demographics
NPI:1720027543
Name:HOWARD, CLEVE WILSON (MD)
Entity Type:Individual
Prefix:
First Name:CLEVE
Middle Name:WILSON
Last Name:HOWARD
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 1:7530 WHISTLESTOP RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6914
Mailing Address - Country:US
Mailing Address - Phone:704-552-1619
Mailing Address - Fax:
Practice Address - Street 1:7530 WHISTLESTOP RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-6914
Practice Address - Country:US
Practice Address - Phone:704-552-1619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00034088207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63894Medicare UPIN
FL96543Medicare ID - Type Unspecified