Individual
CHARLES T. CLEMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
926 RAINTREE PL, LAFAYETTE, CA 94549-4816
(925) 942-0451
Mailing address
926 RAINTREE PL, LAFAYETTE, CA 94549-4816
(925) 942-0451
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
C39170
CA
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
C39170
CA
208000000X
Pediatrics Physician
C39170
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C391700
—
CA
Enumeration date
01/12/2007
Last updated
02/26/2008
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