Provider Demographics
NPI:1457379877
Name:CLONINGER, CLAUDE ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:ROBERT
Last Name:CLONINGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8134
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-286-1700
Mailing Address - Fax:314-286-1799
Practice Address - Street 1:4940 CHILDRENS PL RM 3308
Practice Address - Street 2:ROOM 3308
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1000
Practice Address - Country:US
Practice Address - Phone:314-286-1700
Practice Address - Fax:314-286-1799
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO327032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207580101Medicaid
ILENROLLEDMedicaid
MO029010213Medicaid