Provider Demographics
NPI:1043275506
Name:STRAUGHN, CLIFTON WADE (MD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:WADE
Last Name:STRAUGHN
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 1:105 BUFORD AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3313
Mailing Address - Country:US
Mailing Address - Phone:864-512-5901
Mailing Address - Fax:864-225-1058
Practice Address - Street 1:105 BUFORD AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3313
Practice Address - Country:US
Practice Address - Phone:864-512-5901
Practice Address - Fax:864-225-1058
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01086371OtherRR MEDICARE
SCGP2619Medicaid
SCAS1696410OtherDEA
SCAS1696410OtherDEA
SCP01086371OtherRR MEDICARE