Provider Demographics
NPI:1891831905
Name:MCCLOUD, WILLARD L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:L
Last Name:MCCLOUD
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:204 BECKER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3134
Mailing Address - Country:US
Mailing Address - Phone:252-537-8193
Mailing Address - Fax:252-537-0589
Practice Address - Street 1:204 BECKER DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3134
Practice Address - Country:US
Practice Address - Phone:252-537-8193
Practice Address - Fax:252-537-0589
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2020-11-11
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Provider Licenses
StateLicense IDTaxonomies
NC24685207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8955819Medicaid
NCD26844Medicare UPIN