Provider Demographics
NPI:1013983345
Name:CLARY, LOIS GAIL (MD)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:GAIL
Last Name:CLARY
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:PO BOX 27877
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0877
Mailing Address - Country:US
Mailing Address - Phone:828-694-8350
Mailing Address - Fax:828-694-7654
Practice Address - Street 1:705 6TH AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4164
Practice Address - Country:US
Practice Address - Phone:828-694-8389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39931207RC0200X, 207RP1001X, 207RS0012X
VA0101260422207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
290008578OtherRR MEDICARE
NC8922792Medicaid
NC22792OtherBCBS NC PROVIDER #
NCP01272362OtherRR MEDICARE
NCNCF857AMedicare PIN
NC22792OtherBCBS NC PROVIDER #