Provider Demographics
NPI:1457350878
Name:TEMPLE, CLARENCE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:A
Last Name:TEMPLE
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 1:1400 US HIGHWAY 61
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4100
Mailing Address - Country:US
Mailing Address - Phone:636-933-8050
Mailing Address - Fax:636-933-8075
Practice Address - Street 1:1400 US HIGHWAY 61
Practice Address - Street 2:SUITE 210
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028
Practice Address - Country:US
Practice Address - Phone:636-933-8050
Practice Address - Fax:636-933-8075
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19206207X00000X
TXD1080207X00000X
KY40911207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100018370Medicaid
AR112502001Medicaid
KY000000521650OtherBCBS
OK100154820AMedicaid
TX1027807-01Medicaid
TX1027807-01Medicaid
KYB26905Medicare UPIN
KY00294001Medicare PIN
824351Medicare ID - Type Unspecified