Provider Demographics
NPI:1114991296
Name:SMITH, CLIFTON (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:
Last Name:SMITH
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 1:177 BURT RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2410
Mailing Address - Country:US
Mailing Address - Phone:859-276-1511
Mailing Address - Fax:859-276-3373
Practice Address - Street 1:177 BURT RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2410
Practice Address - Country:US
Practice Address - Phone:859-276-1511
Practice Address - Fax:859-276-3373
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16726207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64167265Medicaid
KY0202601Medicare PIN
KY64167265Medicaid