Provider Demographics
NPI:1568402105
Name:CLIFFORD, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 N MACARTHUR BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2875
Mailing Address - Country:US
Mailing Address - Phone:972-373-0303
Mailing Address - Fax:972-373-8074
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:STE 150
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2875
Practice Address - Country:US
Practice Address - Phone:972-373-0303
Practice Address - Fax:972-373-8074
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3234208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141951701Medicaid
TX141951703Medicaid
TX141951704OtherMEDICAID OTHER
TX141951701Medicaid
TX352201YL7AOtherMEDICARE - OTHER COUNTY
TX83251KMedicare ID - Type Unspecified