Provider Demographics
NPI:1588834634
Name:LEFEVRE, CLINTON ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:ARTHUR
Last Name:LEFEVRE
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 1:195 NAOMI AVE
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-1709
Mailing Address - Country:US
Mailing Address - Phone:805-773-1680
Mailing Address - Fax:
Practice Address - Street 1:195 NAOMI AVE
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-1709
Practice Address - Country:US
Practice Address - Phone:805-773-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC352352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35896Medicare UPIN