Provider Demographics
NPI:1174593370
Name:PODEWELL, CLIFFORD C (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:C
Last Name:PODEWELL
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 1:14300 W GRANITE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5783
Mailing Address - Country:US
Mailing Address - Phone:623-546-8777
Mailing Address - Fax:
Practice Address - Street 1:14300 W GRANITE VALLEY DR
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5783
Practice Address - Country:US
Practice Address - Phone:623-546-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ191081Medicaid
AZWCKJR04Medicare ID - Type Unspecified
AZ69876Medicare ID - Type Unspecified
AZ191081Medicaid
AZ69875Medicare ID - Type Unspecified
AZ69874Medicare ID - Type Unspecified