Provider Demographics
NPI:1568415206
Name:DEPRANG, CLIFFORD L (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:L
Last Name:DEPRANG
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 1:2074 ANTILLEY RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5209
Mailing Address - Country:US
Mailing Address - Phone:325-698-3865
Mailing Address - Fax:325-793-1295
Practice Address - Street 1:2074 ANTILLEY RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5209
Practice Address - Country:US
Practice Address - Phone:325-698-3865
Practice Address - Fax:325-793-1295
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5283207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029951304Medicaid
TX0021GCOtherBCBS
TX146430100OtherFIRSTCARE HMO
TX146430100OtherSOUTHWEST HEALTH