Provider Demographics
NPI:1144366428
Name:LLOYD J. CLEAVER, D.O., L.L.C.
Entity type:Organization
Organization Name:LLOYD J. CLEAVER, D.O., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:CLEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-627-7546
Mailing Address - Street 1:1316 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-5362
Mailing Address - Country:US
Mailing Address - Phone:660-627-7546
Mailing Address - Fax:660-956-7097
Practice Address - Street 1:1316 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-5362
Practice Address - Country:US
Practice Address - Phone:660-627-7546
Practice Address - Fax:660-956-7096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8895207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1295932648OtherNPI (DAVID W. CLEAVER)
MO070004124OtherRAILROAD MEDICARE
MODG4290OtherRAILROAD MEDICARE GROUP #
1104829829OtherNPI
MO2010022125OtherMO LICENSE (DAVID W. CLEAVER)
MO242210912Medicaid
MO501218200Medicaid
1063495463OtherNPI
MO428713812Medicaid
MO242210912Medicaid
MO801434853Medicare PIN
MO035634853Medicare PIN
MO1295932648OtherNPI (DAVID W. CLEAVER)
S29474Medicare UPIN