Provider Demographics
NPI:1407859044
Name:FAULL, CLIFFORD EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:EDWARD
Last Name:FAULL
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 1:80 HEALTHCARE DR
Mailing Address - Street 2:STE 203
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5146
Mailing Address - Country:US
Mailing Address - Phone:828-586-5531
Mailing Address - Fax:828-586-5759
Practice Address - Street 1:80 HEALTHCARE DR
Practice Address - Street 2:STE 203
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5146
Practice Address - Country:US
Practice Address - Phone:828-586-5531
Practice Address - Fax:828-586-5759
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20269207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8931408Medicaid
NC8931408Medicaid
C83714Medicare UPIN
NC206219Medicare PIN