Provider Demographics
NPI:1598768921
Name:CLIFFORD, ROBERT K JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:CLIFFORD
Suffix:JR
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:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-626-2410
Mailing Address - Fax:940-626-2411
Practice Address - Street 1:1851 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3852
Practice Address - Country:US
Practice Address - Phone:940-626-2410
Practice Address - Fax:940-626-2411
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1360207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DY295OtherBCBS
TX033415304Medicaid
TX033415304Medicaid