Provider Demographics
NPI:1235187485
Name:BAYLOR, CLIFTON TY (MD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:TY
Last Name:BAYLOR
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 1:1708 YAKIMA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5309
Mailing Address - Country:US
Mailing Address - Phone:253-363-8700
Mailing Address - Fax:253-363-8759
Practice Address - Street 1:1708 YAKIMA AVE STE 300
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5309
Practice Address - Country:US
Practice Address - Phone:253-363-8700
Practice Address - Fax:253-363-8759
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046177207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00333773OtherRAILROAD MEDICARE
WA1005588Medicaid
WA8449985Medicaid
WAP00333773OtherRAILROAD MEDICARE
WAI21660Medicare UPIN