Provider Demographics
NPI:1467405316
Name:O'MEARA, CLIFTON B (MD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:B
Last Name:O'MEARA
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 1:1904 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7718
Mailing Address - Country:US
Mailing Address - Phone:512-863-4563
Mailing Address - Fax:512-869-5899
Practice Address - Street 1:1904 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7718
Practice Address - Country:US
Practice Address - Phone:512-863-4563
Practice Address - Fax:512-869-5899
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5852207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200041316OtherRAILROAD MEDICARE
TXE72926Medicare UPIN
TXN61BMedicare PIN