Individual
MR. CLIFFORD LOREN MOUDY II
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
I.D.C.
Contact information
Practice address
3001A SIXTH ST, NAVAL HOSPITAL GREAT LAKES, GREAT LAKES, IL 60088-5230
(847) 688-2616
Mailing address
26800 104TH ST, TREVOR, WI 53179-9619
(847) 688-2616
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
03/08/2006
Last updated
07/08/2007
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