Provider Demographics
NPI:1437360526
Name:TITCOMB, CLIFTON PAUL JR (MD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:PAUL
Last Name:TITCOMB
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 1:4514 SCOTIA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9781
Mailing Address - Country:US
Mailing Address - Phone:260-625-6869
Mailing Address - Fax:
Practice Address - Street 1:4514 SCOTIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-9781
Practice Address - Country:US
Practice Address - Phone:260-625-6869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040200A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine