Clary, Kevin Wallace

Clary, Kevin Wallace is an individual health care provider with primary practice located at 1 Hospital Dr , Columbia MO 65212-0001. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Clary, Kevin Wallace can be contacted via phone (573) 884-9066.

Contact Information

Primary practice address
1 Hospital Dr Columbia MO 65212-0001
Phone: (573) 884-9066
Fax: (573) 884-3037
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 01064387A Indiana
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 01064387 Indiana
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 2011034655 Missouri
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 2011034655 Missouri

Profile Details

NPI number 1821280769
LBN Legal business name Clary, Kevin Wallace
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 14th, 2007
Last updated Oct 5th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821280769 NPPES
Indiana MEDICAID 200932900

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