Basic Information
| Provider Information | |||||||||
| NPI: | 1013983345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLARY | ||||||||
| FirstName: | LOIS | ||||||||
| MiddleName: | GAIL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27877 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841270877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286948350 | ||||||||
| FaxNumber: | 8286947654 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 6TH AVE W | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287394164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286948389 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 11/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 39931 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 39931 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | 39931 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RP1001X | 0101260422 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 0101260422 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 290008578 | 01 | RR MEDICARE | OTHER | 8922792 | 05 | NC | MEDICAID | 22792 | 01 | NC | BCBS NC PROVIDER # | OTHER | P01272362 | 01 | NC | RR MEDICARE | OTHER |