Individual
DR. KEVIN WALLACE CLARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 HOSPITAL DR, COLUMBIA, MO 65212-0001
(573) 884-9066
(573) 884-3037
Mailing address
PO BOX 7687, SUITE 500, COLUMBIA, MO 65205-7687
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01064387A
IN
207R00000X
Internal Medicine Physician
Primary
2011034655
MO
208000000X
Pediatrics Physician
01064387
IN
208000000X
Pediatrics Physician
2011034655
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200932900
—
IN
Enumeration date
08/14/2007
Last updated
10/05/2022
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