Provider Demographics
NPI:1336212331
Name:MANLEY, CLOVIS E (MD)
Entity Type:Individual
Prefix:MR
First Name:CLOVIS
Middle Name:E
Last Name:MANLEY
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 1:4943 ROSEBUD LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9226
Mailing Address - Country:US
Mailing Address - Phone:812-471-8195
Mailing Address - Fax:812-490-1060
Practice Address - Street 1:4943 ROSEBUD LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9226
Practice Address - Country:US
Practice Address - Phone:812-471-8195
Practice Address - Fax:812-490-1060
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100085380Medicaid
IN000000843235OtherANTHEM
INP01263645OtherRAILROAD MEDICARE
IN211850Medicare PIN
INQ00009Medicare UPIN
IN211850BMedicare PIN
IN211850AMedicare PIN
IN191640Medicare ID - Type Unspecified
IN4628860001Medicare NSC
IN191640Medicare PIN
ININ1615004Medicare PIN
IND95035Medicare UPIN