Individual
JOHN LARRY CLEMENTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
390 S MAIN ST, SUITE 103, ROCKY MOUNT, VA 24151-1766
(540) 725-1226
(540) 857-5306
Mailing address
390 S MAIN ST, SUITE 103, ROCKY MOUNT, VA 24151-1766
(540) 725-1226
(540) 857-5306
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0103000391
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710920632
AETNA
VA
05
—
1710920632
—
VA
01
—
540506332085
TRICARE/CHAMPUS
VA
01
—
P00624452
RAILROAD MEDICARE
VA
Enumeration date
06/14/2006
Last updated
03/11/2014
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