Provider Demographics
NPI:1629031026
Name:MOWERY, CLIFFORD SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:SCOTT
Last Name:MOWERY
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 1:7502 STATE RD
Mailing Address - Street 2:SUITE 3310
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2596
Mailing Address - Country:US
Mailing Address - Phone:513-624-1240
Mailing Address - Fax:
Practice Address - Street 1:7502 STATE RD
Practice Address - Street 2:SUITE 3310
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2596
Practice Address - Country:US
Practice Address - Phone:513-624-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052205M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00884839OtherMEDICARE RR
OH0663625Medicaid
A52855Medicare UPIN
OH0663625Medicaid