Provider Demographics
NPI:1588664510
Name:CARTWRIGHT, CLIFTON C (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:C
Last Name:CARTWRIGHT
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 1:517 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-3709
Mailing Address - Country:US
Mailing Address - Phone:662-728-8136
Mailing Address - Fax:662-728-6353
Practice Address - Street 1:517 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-3709
Practice Address - Country:US
Practice Address - Phone:662-728-8136
Practice Address - Fax:662-728-6353
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00071651Medicaid
MS00017651Medicaid
B64756Medicare UPIN
MSB64756Medicare UPIN
MS00071651Medicaid