Provider Demographics
NPI:1245260967
Name:YUT, CLIFFORD W (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:W
Last Name:YUT
Suffix:
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 1:8000 RESEARCH FOREST DRIVE
Mailing Address - Street 2:STE 360
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382
Mailing Address - Country:US
Mailing Address - Phone:281-292-1191
Mailing Address - Fax:281-362-9170
Practice Address - Street 1:8000 RESEARCH FOREST DRIVE
Practice Address - Street 2:STE 360
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382
Practice Address - Country:US
Practice Address - Phone:281-292-1191
Practice Address - Fax:281-362-9170
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2830207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M5232OtherBLUE CROSS BLUE SHIELD
TX8D0625Medicare ID - Type Unspecified
H30265Medicare UPIN