Provider Demographics
NPI:1821264052
Name:CLIFFORD CARROL MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CLIFFORD CARROL MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-838-0604
Mailing Address - Street 1:10313 ORKINEY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4316
Mailing Address - Country:US
Mailing Address - Phone:702-838-0604
Mailing Address - Fax:
Practice Address - Street 1:10313 ORKINEY DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-4316
Practice Address - Country:US
Practice Address - Phone:702-838-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8160207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty