Provider Demographics
NPI:1861472797
Name:FLORY, CLYDE R JR (MD)
Entity type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:R
Last Name:FLORY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4169 LEGACY PKWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4258
Mailing Address - Country:US
Mailing Address - Phone:517-394-6500
Mailing Address - Fax:517-393-4202
Practice Address - Street 1:4169 LEGACY PKWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4258
Practice Address - Country:US
Practice Address - Phone:517-394-6500
Practice Address - Fax:517-393-4202
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MICF024139207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1268880Medicaid
MI0332777Medicare ID - Type Unspecified
MI1268880Medicaid