Provider Demographics
NPI:1679690044
Name:CLONIGER, CHARLES H III (NP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:H
Last Name:CLONIGER
Suffix:III
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 POTRERO AVE # 4J
Mailing Address - Street 2:SFGH URGENT CARE
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-8052
Mailing Address - Fax:415-355-7407
Practice Address - Street 1:1001 POTRERO AVE # 4J
Practice Address - Street 2:SFGH URGENT CARE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8052
Practice Address - Fax:415-355-7407
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN351454163WM0705X
CANPF10167363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
966937OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
966937OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER