Individual
JOHN R CLEMENTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
3 RIVERSIDE CIR, ROANOKE, VA 24016-4955
(540) 725-1226
(540) 857-5306
Mailing address
3 RIVERSIDE CIR, ROANOKE, VA 24016-4955
(540) 725-1226
(540) 857-5306
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0103300956
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629012208
VIRGINIA HEALTH NETWORK
VA
05
—
1629012208
—
VA
01
—
371194700
BLACK LUNG
VA
01
—
3810011217
MEDICAID OF WEST VIRGINIA
VA
01
—
540506332108
TRICARE
VA
01
—
P00403951
RAILROAD MEDICARE
VA
Enumeration date
06/15/2006
Last updated
03/21/2014
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