Provider Demographics
NPI:1821046715
Name:ROBERSON, CLIFFORD WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:WILLIAM
Last Name:ROBERSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CLIFFORD
Other - Middle Name:W
Other - Last Name:ROBERSON
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3009 JACKSON AVE
Mailing Address - Street 2:PO BOX 601
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-1717
Mailing Address - Country:US
Mailing Address - Phone:304-675-8095
Mailing Address - Fax:304-675-8096
Practice Address - Street 1:3009 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1717
Practice Address - Country:US
Practice Address - Phone:304-675-8095
Practice Address - Fax:304-675-8096
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22760207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3910007237Medicaid
OH0143290Medicaid
WV3910007237Medicaid