Provider Demographics
NPI:1942283700
Name:CLIBURN, ELIZABETH ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:CLIBURN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4560 WINDING RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-6518
Mailing Address - Country:US
Mailing Address - Phone:209-824-5045
Mailing Address - Fax:209-824-5028
Practice Address - Street 1:1721 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5130
Practice Address - Country:US
Practice Address - Phone:209-824-5051
Practice Address - Fax:209-824-5028
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02002820A207Q00000X
CA20A8830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN178730PMedicare ID - Type Unspecified
I19305Medicare UPIN