Provider Demographics
NPI:1275574196
Name:JANKE, CLIFFORD O (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:O
Last Name:JANKE
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 1:630 N. ALVERNON WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-0000
Mailing Address - Country:US
Mailing Address - Phone:520-647-8850
Mailing Address - Fax:520-647-8851
Practice Address - Street 1:1601 W. ST. MARY'S RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2623
Practice Address - Country:US
Practice Address - Phone:520-872-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6766207P00000X
AZ30653207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine