Provider Demographics
NPI:1295932648
Name:CLEAVER, DAVID WESLEY (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WESLEY
Last Name:CLEAVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:660-956-7097
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010022125207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2010022125OtherLICENSE
501218200OtherMEDICAID GROUP
000014853OtherMEDICARE GROUP
148530001Medicare PIN