Provider Demographics
NPI:1184753154
Name:MAHAFFEY, CLIFFORD W (LPO, CPO,BOC,PO)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:W
Last Name:MAHAFFEY
Suffix:
Gender:M
Credentials:LPO, CPO,BOC,PO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 W AMARILLO BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1936
Mailing Address - Country:US
Mailing Address - Phone:806-358-2343
Mailing Address - Fax:806-358-2920
Practice Address - Street 1:6103 W AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1936
Practice Address - Country:US
Practice Address - Phone:806-358-2343
Practice Address - Fax:806-358-2920
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies