Provider Demographics
NPI:1003420464
Name:KILCREASE, CLINTON TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:TAYLOR
Last Name:KILCREASE
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 1:1704 S FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-7306
Mailing Address - Country:US
Mailing Address - Phone:334-335-3383
Mailing Address - Fax:334-335-3078
Practice Address - Street 1:1704 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-7306
Practice Address - Country:US
Practice Address - Phone:334-335-3383
Practice Address - Fax:334-335-3078
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.43478207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine