Provider Demographics
NPI:1346205507
Name:SALMON, CLIFTON WALES JR (MD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:WALES
Last Name:SALMON
Suffix:JR
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:PO BOX 300
Mailing Address - Street 2:104 MORRIS CIRCLE
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-0300
Mailing Address - Country:US
Mailing Address - Phone:318-927-6777
Mailing Address - Fax:318-927-6714
Practice Address - Street 1:104 MORRIS CIR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-2100
Practice Address - Country:US
Practice Address - Phone:318-927-6777
Practice Address - Fax:318-927-6714
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018524207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1358827Medicaid
LAB65328Medicare UPIN
LA1358827Medicaid