Provider Demographics
NPI:1629144837
Name:KORF, CLIFFORD D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:D
Last Name:KORF
Suffix:
Gender:M
Credentials:PA-C
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 1800
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602-1800
Mailing Address - Country:US
Mailing Address - Phone:402-564-7118
Mailing Address - Fax:402-562-3378
Practice Address - Street 1:4600 38TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1664
Practice Address - Country:US
Practice Address - Phone:402-564-7118
Practice Address - Fax:402-562-3378
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE954363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063919813Medicaid
NE38619OtherBCBS NE FOR CCH
0423750001Medicare NSC
NE47063919813Medicaid
NE096576001Medicare PIN
NE279850Medicare PIN