Provider Demographics
NPI:1356427736
Name:MOHR, CLINTON JAY (MD)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:JAY
Last Name:MOHR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1008 W CHERRY ST
Mailing Address - Street 2:STE D
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1998
Mailing Address - Country:US
Mailing Address - Phone:618-997-2396
Mailing Address - Fax:618-997-1901
Practice Address - Street 1:1008 W CHERRY ST
Practice Address - Street 2:STE D
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1998
Practice Address - Country:US
Practice Address - Phone:618-997-2396
Practice Address - Fax:618-997-1901
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2006030252207R00000X
IL036119956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine