1003834086 NPI number — DR. MARK ANDREW CLIFFORD MD

Table of content: SIDDHARTH MISHRA (NPI 1316534423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003834086 NPI number — DR. MARK ANDREW CLIFFORD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLIFFORD
Provider First Name:
MARK
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003834086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 1ST AVE
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
FAIRBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99701-4803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-750-4124
Provider Business Mailing Address Fax Number:
808-433-1558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-4803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-750-4124
Provider Business Practice Location Address Fax Number:
808-433-1558
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  13429 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 13429 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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