Provider Demographics
NPI:1992899645
Name:CLAY, ANGELA COLEEN MOORE (DO)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:COLEEN MOORE
Last Name:CLAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-9210
Mailing Address - Country:US
Mailing Address - Phone:417-533-6350
Mailing Address - Fax:417-533-6350
Practice Address - Street 1:1059 BARTON DR
Practice Address - Street 2:
Practice Address - City:FORDLAND
Practice Address - State:MO
Practice Address - Zip Code:65652-7350
Practice Address - Country:US
Practice Address - Phone:417-767-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO2001026670207P00000X, 207PE0004X
MO2001026670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209221001Medicaid
MOP00750135OtherRAILROAD MEDICARE
MO902840220Medicare PIN
MOP00750135OtherRAILROAD MEDICARE