Basic Information
| Provider Information | |||||||||
| NPI: | 1063498533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEMENTS | ||||||||
| FirstName: | LLOYD | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40480 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366400480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514705842 | ||||||||
| FaxNumber: | 2514705809 | ||||||||
| Practice Location | |||||||||
| Address1: | 1504 SPRINGHILL AVE | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366043207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514343915 | ||||||||
| FaxNumber: | 2514343802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 00023115 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208D00000X | 23115 | AL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 00709300 | 05 | MS | MEDICAID | 276517900 | 05 | FL | MEDICAID | 51536493 | 01 | AL | BCBS | OTHER | 1583669 | 05 | LA | MEDICAID | 009938906 | 05 | AL | MEDICAID |