Active NPI
Larry Russel Clevenger, M.D.
- Occupational Medicine Physician
- Albuquerque, NM
National Provider Identifier
1558404202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Medicine Physician
- License
- 75-126
- Practice address
- 1515 Eubank Blvd NE
Albuquerque, NM 87112-4112 - Phone
- (505) 845-8037
- NPI assigned
- Feb 14, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Medicine Physician | 2083X0100X | 75-126 | NM | Primary |
Addresses
Primary practice location
1515 Eubank Blvd NE
Albuquerque, NM 87112-4112
Mailing address
1515 Eubank Blvd NE
Albuquerque, NM 87112-4112
Phone (505) 845-8037
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75-126 | NM | MD | Occupational Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378771200000",
"number": "1558404202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 EUBANK BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871124112",
"telephone_number": "505-845-8037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 EUBANK BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871124112",
"telephone_number": "505-845-8037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEVENGER",
"first_name": "LARRY",
"middle_name": "RUSSEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-14",
"last_updated": "2013-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "2083X0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Occupational Medicine",
"state": "NM",
"license": "75-126",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.