Provider Demographics
NPI:1679521405
Name:CLIFTON, MILDRED MURPHY (MD)
Entity Type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:MURPHY
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MISSY
Other - Middle Name:
Other - Last Name:CLIFTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:901 SE PLAZA AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5697
Mailing Address - Country:US
Mailing Address - Phone:479-273-3376
Mailing Address - Fax:479-273-3468
Practice Address - Street 1:901 SE PLAZA AVE
Practice Address - Street 2:STE 5
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5697
Practice Address - Country:US
Practice Address - Phone:479-273-3376
Practice Address - Fax:479-273-3468
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3363207NI0002X, 207N00000X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04D1034086OtherCLIA
AR150037001Medicaid
AR155059002Medicaid
AR5M432OtherBCBS #
AR5M432OtherBCBS #
AR155059002Medicaid
ARH77384Medicare UPIN
ARDC6671Medicare ID - Type UnspecifiedRAILROAD GROUP #
AR5F179Medicare ID - Type UnspecifiedGROUP #