Provider Demographics
NPI:1356337364
Name:FLETCHER, CLINTON L (MD)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:L
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6190 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6969
Mailing Address - Country:US
Mailing Address - Phone:850-476-9236
Mailing Address - Fax:850-471-0557
Practice Address - Street 1:6190 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6969
Practice Address - Country:US
Practice Address - Phone:850-476-9236
Practice Address - Fax:850-471-0557
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL54288207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94349Medicare UPIN
FL81419ZMedicare ID - Type Unspecified