Individual
CLINTON J. PACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MERCY WAY STE 440, JOPLIN, MO 64804-4524
(417) 781-4404
(417) 781-5845
Mailing address
100 MERCY WAY, STE 440, JOPLIN, MO 64804-4524
(417) 781-4404
(417) 781-5845
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2015004740
MO
208600000X
Surgery Physician
J1750
TX
2086S0102X
Surgical Critical Care Physician
J1750
TX
2086S0127X
Trauma Surgery Physician
J1750
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821234717
—
MO
01
—
8CX885
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/23/2008
Last updated
09/19/2017
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