Provider Demographics
NPI:1831229772
Name:CLOUD, DAVID HENRY JR (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HENRY
Last Name:CLOUD
Suffix:JR
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 11503
Mailing Address - Street 2:405 BASS STREET
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46858
Mailing Address - Country:US
Mailing Address - Phone:260-438-4341
Mailing Address - Fax:
Practice Address - Street 1:1098 S ST. RD 25
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-6723
Practice Address - Country:US
Practice Address - Phone:574-722-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01013236A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice