Individual
DR. JOHN W CLOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5057 S GLENHAVEN AVE, SPRINGFIELD, MO 65804-7800
(417) 887-7914
Mailing address
5057 S GLENHAVEN AVE, SPRINGFIELD, MO 65804-7800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
R5B59
MO
2085R0001X
Radiation Oncology Physician
Primary
R5B59
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148380071
MEDICARE PTAN
MO
05
—
201574423
—
MO
Enumeration date
06/13/2005
Last updated
01/11/2023
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