Provider Demographics
NPI:1649325390
Name:SMITH, CLIFTON A
Entity type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5931 S HIGHWAY 94
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-5611
Mailing Address - Country:US
Mailing Address - Phone:636-441-7300
Mailing Address - Fax:636-477-6001
Practice Address - Street 1:5931 S HIGHWAY 94
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-5611
Practice Address - Country:US
Practice Address - Phone:636-441-7300
Practice Address - Fax:636-477-6001
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1118092084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry