Provider Demographics
NPI:1487644910
Name:WHIGHAM, CLIFF J JR (DO)
Entity Type:Individual
Prefix:
First Name:CLIFF
Middle Name:J
Last Name:WHIGHAM
Suffix:JR
Gender:M
Credentials:DO
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 3119
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3119
Mailing Address - Country:US
Mailing Address - Phone:713-481-3533
Mailing Address - Fax:713-432-0221
Practice Address - Street 1:4600 E SAM HOUSTON PKWY S
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3948
Practice Address - Country:US
Practice Address - Phone:713-481-3533
Practice Address - Fax:713-432-0221
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF00772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132270302Medicaid
TX132270309Medicaid
TX132270308Medicaid
TX8AM781OtherBCBS
TX132270303Medicaid
TX132270308Medicaid
TX132270302Medicaid
TX8K4932Medicare PIN
TX85R232Medicare PIN
TX8AM781OtherBCBS
TX132270303Medicaid