Individual
CLYDE MORRIS PENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
512 CROFTON PARK LN, FRANKLIN, TN 37069-6516
(850) 218-3404
(850) 474-8096
Mailing address
14055 VALLEY VIEW LN, DALLAS, TX 75244
(877) 868-5351
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD0000057227
TN
207RN0300X
Nephrology Physician
ME36307
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009935449
—
AL
05
—
065065000
—
FL
01
—
17471
BLUE CROSS BLUE SHIELD
FL
01
—
5904025
AETNA
—
Enumeration date
12/16/2005
Last updated
11/09/2021
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