Provider Demographics
NPI:1790906279
Name:CLOWARD, TENNILLE (MD)
Entity Type:Individual
Prefix:
First Name:TENNILLE
Middle Name:
Last Name:CLOWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 E 200 N
Mailing Address - Street 2:STE 250
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2028
Mailing Address - Country:US
Mailing Address - Phone:801-855-2980
Mailing Address - Fax:
Practice Address - Street 1:1159 E 200 N
Practice Address - Street 2:STE 250
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2028
Practice Address - Country:US
Practice Address - Phone:801-855-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-048721207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology