Provider Demographics
NPI:1043391758
Name:CLYBOURN, CLYDE CORWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:CORWIN
Last Name:CLYBOURN
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 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:844-630-0700
Mailing Address - Fax:877-374-1924
Practice Address - Street 1:1211B E CLIFF DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4734
Practice Address - Country:US
Practice Address - Phone:915-591-6226
Practice Address - Fax:915-308-9433
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
714478OtherMEDICARE
TX193932408Medicaid
TXP01249697OtherRAILROAD RETIREMENT MEDICARE
NM36277029Medicaid
NM36277029Medicaid