Provider Demographics
NPI:1750491874
Name:STRONG, CLINTON RILEY III (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:RILEY
Last Name:STRONG
Suffix:III
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 1:1515 W WADE ST
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2325
Mailing Address - Country:US
Mailing Address - Phone:405-262-2262
Mailing Address - Fax:405-262-9400
Practice Address - Street 1:1515 W WADE ST
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2325
Practice Address - Country:US
Practice Address - Phone:405-262-2262
Practice Address - Fax:405-262-9400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100109960BMedicaid