Provider Demographics
NPI:1730181017
Name:STETSON, CLOYCE L (MD)
Entity type:Individual
Prefix:
First Name:CLOYCE
Middle Name:L
Last Name:STETSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-3596
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:SUITE 4A100
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-9400
Practice Address - Country:US
Practice Address - Phone:806-743-1842
Practice Address - Fax:806-743-1105
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9557207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119034002Medicaid
TX119034001Medicaid
TX80580SOtherBC/BS
TX80948ZOtherHMO BLUE
OK100163190AMedicaid
NMS4956Medicaid
TX124783101Medicaid
TX124783100OtherFIRSTCARE COMMERCIAL
NM201021543OtherPRESBYTERIAN COMMERCIAL
NM201021543Medicaid
A363OtherTRIWEST