Individual
MR. CLEAUTRY H MCDANIEL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
501 S RANCHO DR, #E33, LAS VEGAS, NV 89106-4828
(704) 476-4987
(702) 541-8377
Mailing address
501 S RANCHO DR, #E33, LAS VEGAS, NV 89106-4828
(704) 476-4987
(702) 541-8377
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30-0474098
FEDERAL TAX ID
NV
Enumeration date
05/27/2008
Last updated
05/27/2008
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