Provider Demographics
NPI:1669434726
Name:CLOWARD, DAVIS L (MD)
Entity type:Individual
Prefix:
First Name:DAVIS
Middle Name:L
Last Name:CLOWARD
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:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-4820
Mailing Address - Fax:
Practice Address - Street 1:291 BROAD ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2932
Practice Address - Country:US
Practice Address - Phone:336-993-8181
Practice Address - Fax:336-996-9539
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891232PMedicaid
H26783Medicare UPIN
NC2279849Medicare ID - Type Unspecified