Individual
GEORGE B CLAVENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
02159
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0238295
—
IA
01
—
180004154
RR MEDICARE
IA
Enumeration date
08/17/2005
Last updated
07/16/2018
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