Provider Demographics
NPI:1063467132
Name:CLIFTON, BOBBY GLENN II (MD)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:GLENN
Last Name:CLIFTON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:201 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3917
Practice Address - Country:US
Practice Address - Phone:704-487-3000
Practice Address - Fax:704-476-7416
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9300668207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4597856OtherAETNA
NC23083OtherBCBSNC
NC85328OtherMEDCOST
NC7279095001OtherCIGNA
NC8923083Medicaid
SCN00661Medicaid
NC050046483OtherRAILROAD MEDICARE
NC8923083Medicaid
NC2194666DMedicare PIN