Provider Demographics
NPI:1689638561
Name:CLEARFIELD, MICHAEL B (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:CLEARFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 CLUB DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94592
Mailing Address - Country:US
Mailing Address - Phone:707-638-5205
Mailing Address - Fax:707-638-5225
Practice Address - Street 1:365 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5700
Practice Address - Country:US
Practice Address - Phone:707-784-2001
Practice Address - Fax:707-784-1494
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5869207R00000X
CA20A9719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134699104Medicaid
TXD97275Medicare UPIN
TX842557Medicare ID - Type Unspecified