Provider Demographics
NPI:1629012208
Name:CLEMENTS, JOHN R (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:3 RIVERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4955
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:3 RIVERSIDE CIR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4955
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0103300956213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1629012208OtherVIRGINIA HEALTH NETWORK
VA1629012208OtherHEALTHKEEPERS
VA1629012208Medicaid
VA371194700OtherBLACK LUNG
VA1629012208OtherAETNA
VA1629012208OtherHUMANA MEDICARE
VA3810011217OtherMEDICAID OF WEST VIRGINIA
VA1629012208OtherANTHEM
VA1629012208OtherOPTIMA HEALTH PLAN
VA1629012208OtherUNITED HEALTHCARE
VA1629012208OtherVA PREMIER
VA1629012208OtherNPI
VA1629012208OtherCAREWORKS
VA1629012208OtherHEALTHKEEPERS PLUS
VA1629012208OtherUMWA
VA1629012208OtherCIGNA
VA1629012208OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VAP00403951OtherRAILROAD MEDICARE
VA1629012208OtherGATEWAY
VA1629012208OtherMAJESTACARE
VA1629012208OtherINTOTAL
VA540506332108OtherTRICARE
VA1629012208OtherINTOTAL