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Individual
CLYDEEVE A SHREVE
Active
Individual
CLYDEEVE A SHREVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
101694-0501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5177150001
DEMERK PROVIDER ID
UT
01
—
P00100541
RR MEDICARE PROVIDER ID
UT
Enumeration date
09/27/2006
Last updated
07/09/2007
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