Provider Demographics
NPI:1841476959
Name:DR EVELYN M CLOUD P.A.
Entity type:Organization
Organization Name:DR EVELYN M CLOUD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-534-3316
Mailing Address - Street 1:8211 MAR DEL PLATA ST E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7349
Mailing Address - Country:US
Mailing Address - Phone:904-534-3316
Mailing Address - Fax:904-620-9748
Practice Address - Street 1:8211 MAR DEL PLATA ST E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7349
Practice Address - Country:US
Practice Address - Phone:904-388-4561
Practice Address - Fax:904-620-9748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1367332B00000X
213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480001452OtherMEDICARE RAILROAD
FL041331300Medicaid