Provider Demographics
NPI:1760461974
Name:CLEVINGER, SIDNEY ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:ERNEST
Last Name:CLEVINGER
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 1:2405 SE 17TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9192
Mailing Address - Country:US
Mailing Address - Phone:352-690-2171
Mailing Address - Fax:352-690-6954
Practice Address - Street 1:2415 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-2618
Practice Address - Country:US
Practice Address - Phone:352-732-5365
Practice Address - Fax:352-732-5372
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045618700Medicaid
FL02983OtherBCBS
FL080071713OtherRR MEDICARE
FL02983OtherBCBS
FL02983WMedicare PIN
FL080071713OtherRR MEDICARE